TriCore Provider Portal Opt-Out Information

UNDERSTANDING YOUR REQUEST

TriCore supports a Provider Portal that allows your health information to be accessed through a secure, electronic network by your doctors, hospitals, and other health care providers. This means that information that could help save your life in a medical emergency is available to your health care providers.

If you do not want your health care providers to have access to your health information in the Provider Portal, you can choose to “Opt-Out” by completing the Opt-Out Request Form below and submitting your request through this page. If you submit the Opt-Out Request Form, you understand that:

1. TriCore will not allow access to your health information through the Provider Portal, even in an emergency. As a result, you agree to waive any claims against TriCore for any harm caused by the exclusion of your information from the Provider Portal.
2. Your Opt-Out Request does not prevent your health care providers from requesting and receiving your health information from TriCore using other methods, such as fax, telephone, email, or mail.
3. This Opt-Out Request does NOT mean that you are opting out of any other Portal or Health Information Exchange in which TriCore participates, including:

New Mexico HIE - TriCore participates in New Mexico’s electronic PHI exchange (HIE). An HIE is a platform for the secure exchange of PHI among different healthcare organizations and health plans. To Opt-Out of the HIE, follow the instructions here: https://www.syncronys.org/resources/#for-patients

TriCore’s Payer Portal - TriCore hosts a web-based portal so health plans may access your PHI for operational purposes such as quality measure adherence, care coordination, and treatment authorization. This portal is restricted to the insurance responsible for your coverage and/or the provider responsible for your care. When you pay for lab services in cash, you will be opted out of TriCore’s Payer Portal.

After receiving your request, TriCore will contact you through the communication method of your choice to confirm your information and obtain your approval to finalize your Opt-Out.

Your request to Opt-Out of the Provider Portal will be effective once TriCore has received and processed  your Opt-Out Request, and in no event later than thirty (30) days from our receipt of your completed Opt-Out Request. Your request to Opt-Out of the Provider Portal will not apply to any health information accessed before the date that we have completed processing your Opt-Out Request and your Opt-Out becomes effective. Your Provider Portal Opt-Out Request will remain in effect unless you complete and submit the “Revoke Opt-Out” form.

Please fill out the form below to either Opt-Out or Revoke your previously submitted Opt-Out from the Provider Portal.