1. Authorization
I authorize my health plans/insurers and health care providers (and their business associates) to disclose my protected health information ("PHI") to Medical Bill and its service providers solely to audit bills/claims and to prepare, submit, and track disputes/appeals and related requests.
2. Information Authorized
PHI related to the dates of service and claims at issue, including:
- Itemized statements
- Claim files and adjudication notes
- EOBs/ERAs
- Enrollment/coverage and accumulator data
- Prior-authorization/referral info
- Relevant clinical notes supporting coding/medical necessity
- UB-04/CMS-1500 forms
- Plan documents (EOC/SBC)
Psychotherapy notes are not requested.
3. Who May Disclose
Any of my health plans/insurers, TPAs (third-party administrators), and health care providers that maintain the records described above.
4. To Whom
Medical Bill and its subcontracted service providers (fax, mail, cloud storage, virtual mailbox) acting on its behalf.
Medical Bill will use reasonable safeguards and the minimum necessary information.
5. How Disclosed
Medical Bill may receive PHI by fax, mail, secure email/portal, or other electronic means and communicate with me electronically about my case.
6. Expiration
This Authorization expires 12 months after my last case activity, unless revoked earlier.
7. Right to Revoke
I may revoke this Authorization in writing at any time by emailing support@medicalbill.pro.
Revocation will not apply to disclosures already made in reliance on this Authorization.
8. Refusal / No Conditions
Treatment, payment, enrollment, or eligibility may not be conditioned on signing this Authorization.
Medical Bill is not a provider or health plan.
9. Redisclosure
PHI disclosed to Medical Bill may be subject to redisclosure by Medical Bill as permitted by this Authorization and may no longer be protected by HIPAA, though Medical Bill commits to safeguard it and use it only for the purposes stated.
10. Contact
If you have any questions about this HIPAA Authorization, please contact us at:
Email: support@medicalbill.pro