Change Request Detail
Type of Request
Institutional Claim (UB-92)
DSMO Process Completed
Business Reason
The Federal Substance Abuse Rules (FSAR) impose restrictions on the use and disclosure of alcohol and drug abuse patient records that are maintained in connection with the performance of any federally assisted alcohol and drug abuse program. FSAR protected records must not be used or disclosed without the individualís written authorization. Any disclosure made pursuant to the individualís authorization must be accompanied by a specific written statement that indicates the records are FSAR protected and thus should not be further disclosed.
Perhaps the CLM12 with a Yes/No indicator can be set aside for FSAR. CLM09 seems HIPAA privacy driven, not FSAR. While CLM09 and OI give permission to submit for processing, a mechanism is also needed to alert payer that any further use is not allowed.
DSMO Category
Disapprove. There is an exception to the Federal Substance Abuse Rules (FSAR) for treatment payment purposes. Payers may not redisclose this information without a specific consent which would be addressed as part of the process to request a Payer to disclose the data. Payers are also subject to HIPAA Privacy & Security regulations when disclosing for payment purposes. Therefore, no separate indicator is needed or warranted on an inbound claim.
Appeal Recommendation