CurrentHighmark DelawarePolicy N/A

Case Management Agreement and Medical Information Release

This document governs member enrollment in Highmark Delaware's Case Management Program and authorizes release of medical information to the case manager; it affects members and their authorized representatives and care teams.

Policy Summary

PayerHighmark Delaware

PolicyCase Management Agreement and Medical Information Release

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateN/A

Next Review DateN/A

Key ActionBy signature, member authorizes release of medical information to the case manager for creation, updating and review of the care plan.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

1 yearagreement duration

no costcost to member

signature requiredmember action

possible losscoverage risk

Coverage and Participation Conditions

Stance and conditions regarding coverage and program participation:

Case management services are provided at no additional cost to the member.

Participation in case management is voluntary, except where participation is required for certain benefits.

If a member leaves the case management program, services that require case management participation will no longer be covered.

The agreement is active for one year from the date signed or until the member is no longer enrolled in the Service Benefit Plan.

Members may leave the program at any time by contacting their case manager and will continue to receive benefits outlined in the Service Benefit Plan brochure after case management services end, except for services requiring participation.

Policy Summary

PayerHighmark Delaware

PolicyCase Management Agreement and Medical Information Release

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateN/A

Next Review DateN/A

Key ActionBy signature, member authorizes release of medical information to the case manager for creation, updating and review of the care plan.

SourceLink

On This Page

Provider Actions and Authorizations

Documentation Required

Release Authorization — member signature permits release of medical information

By signing the agreement, the member (or authorized representative) authorizes the release of medical information to the case manager so the case manager may create, update, and review the member's care plan. This authorization is granted by the member's signature on the Case Management Agreement Form.

Note

Outreach Permission — case manager may contact member and care team

The case manager is permitted to contact the member and/or the member's care team to discuss the member's healthcare needs; the care team includes the member's authorized representative and healthcare providers. This outreach is authorized as part of participation in the Case Management Program.

Definitions

Care team — definition

DefinitionCare team includes the member's authorized representative and healthcare providers (hospital staff, doctors, therapists, etc.).

IncludesAuthorized representative (if applicable).

IncludesHealthcare providers such as hospital staff, doctors, and therapists.

RoleCare team members may be contacted by the case manager to discuss the member's healthcare needs.

Case Management Program — definition

ProgramCase Management Program offered by Highmark to coordinate member healthcare needs.

Cost to memberNo additional cost to the member for case management services.

ParticipationParticipation is voluntary, but may be required for some benefits.

Leaving the programMembers may leave at any time by contacting their case manager; leaving may cause services that require participation to no longer be covered.

Agreement durationAgreement is active for one year from the date signed or until the member is no longer enrolled in the Service Benefit Plan.