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Back  RFI # 855: Purpose of Confidentiality Cde

Formal vs. Informal Help Informal Formal


Kenney Timmie


I am requesting clarification on the new 5010 Confidentiality Code INS13 in the 2000 loop. In HHS documentation it indicates this code was added to address a privacy issue. The guide indicates "Required when the member has specified the access
to their information".

If a member has requested restricted access what functionality should this drive in a claims processing system - callers (Provider, Subscriber) cannot get any info on the member? No correspondence is to be sent to anyone but the member? If yes is the member Member Mail address to be used if it exists and if it does not use the residential.

Related to address and mailing correspondence is the hierarchy drop location address, then member address and finally residential address

thank you


The Confidentiality Code was intended as a way for a group to notify a plan that this member’s information needs to be flagged under their confidentiality process. The implementation guide is not dictating plan’s confidentiality processes. Health Plans will have their own confidentiality processes.

If residential address is the only address then everything is sent to that address. If you have a mailing address and no drop off location then shipments and mail will go to that address. If you have a drop off location then shipments will be sent to that drop off location and mail will go to the mailing address (if sent) or residential address.


Submission 9/11/2009
Status Date 10/16/2009
Status F - Final
Primary References
Document 005010X220