Data+Segmentation+User+Story+2

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User Story 2 – (Share Partial) Patient X goes to a Healthcare Provider Organization for a certain condition, receives treatment for the diagnosis and pays for the services out-of-pocket. Since the Patient paid for the services out-of-pocket he/she informs the Healthcare Provider Organization to withhold Payer access to data related to the treatment received. In order to be compliant with HITECH §13405 and Proposed Rule 45 CFR Part 164.522(a)(1)(iv) the Healthcare Provider Organization enters the Patient data and disclosure preference into their EHR system. In addition to receiving care from the Healthcare Provider Organization the Patient had a routine blood test unrelated to the condition mentioned above, which he/she did not pay for out-of-pocket. The laboratory sent the claim to the Patient’s Payer. The Payer sends an electronic information request to the Healthcare Provider Organization for Patient X’s treatment and services that led to the request for blood work, before approving payment. Healthcare Provider Organization responds to the information request and electronically sends the subset of data unrelated to the condition for which Patient X paid for services out-of-pocket. The Payer Information system receives the information relating to Patient’s blood work but not the full encounter information.



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