Request to Amend PHI

Op10.03-12 Request to Amend PHI

Applies to the Administrative Requirements of the Health Insurance Portability and Accountability Act of 1996. 45 CFR Section 164.526(a)

Policy

Participants have the right to request amendment of incorrect or incomplete Protected Health Information ("PHI") contained in the designated record set.

Procedure

  • Requests for amendment of PHI must be made in writing to the Human Resources Assistant Director and must include a reason to support acceptance of the amendment.
  • If the request for amendment is not received in writing, or if the written request does not include a reason in support of the request, the Employee Benefit Plan will not act on the request.
  • When a request for amendment of PHI is received, it will be acted on within sixty (60) days. If necessary, this time frame may be extended for thirty (30) days. The individual requesting the amendment will be informed in writing of the reason(s) for the delay and the date by which action will be taken on the request. The extension notice will be provided within sixty (60) days of receipt of the original request.
  • The Employee Benefit Plan documents the titles of the persons/offices responsible for receiving and processing requests for amendment and retains such documentation for a period of six (6) years.
When a request for amendment is denied:
  • The participant is given a notice written in plain language that:
    • Includes a permissible basis for denial*;
    • Informs the participant of the right to submit a statement of disagreement, and how to file the statement;
    • States that if the participant does not file a statement of disagreement the participant may request that the Employee Benefit Plan provide the request for amendment and the denial in any future release of the disputed PHI; and
    • Includes a description of the procedure to file a complaint with the Employee Benefit Plan or DHHS.
  • If the individual chooses to write a statement of disagreement with the denial decision:
    • The Employee Benefit Plan may write a rebuttal statement and will provide a copy to the participant; and
    • The Employee Benefit Plan will include the request for amendment, denial letter, statement of disagreement, and rebuttal (if any), with any future disclosures of the disputed PHI.
  • If the participant does not choose to write a statement of disagreement with the denial decision, the Employee Benefit Plan is not required to include the request for amendment and denial decision letter with future disclosures of the disputed PHI unless requested by the participant.
When a request for amendment is accepted (in whole or in part):
  • The Employee Benefit Plan will identify the record(s) that are the subject of the amendment request and will append the amendment to the record(s).
  • The Employee Benefit Plan will inform the participant that his or her request for amendment has been accepted and request the identification of and permission to contact other individuals or health care entities that need to be informed of the amendment(s).
  • The Employee Benefit Plan will make reasonable efforts to provide the amendment within a reasonable time to the persons/entities identified by the participant as well as persons and Business Associates who the Employee Benefit Plan knows have the disputed PHI and may rely on it to the participant's detriment.
Receipt of notification of amendment from other Covered Entities:
  • When the Employee Benefit Plan receives notification from another Covered Entity that a participant's PHI has been amended:
    • The Employee Benefit Plan will ensure that the amendment is appended to all applicable records of the participant, and
    • The Employee Benefit Plan will inform its Business Associates that may use or rely on the participant's PHI of the amendment and require them to make the necessary corrections.

* The information requested was not created by the Health Plan, is accurate and complete, is not part of the record, or may not legally be changed (e.g., information compiled in anticipation of a civil, criminal or administrative proceeding).

Effective Date: April 14, 2003