TriCore’s Notice of Privacy Practices
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED, AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
TriCore Reference Laboratories, TriCore Laboratory Services Corporation, and TriCore, Inc. (collectively, TriCore, we, our, us) are required by law and/or agree to maintain the privacy of your protected health information (PHI), to provide notice of our legal duties and privacy practices with respect to PHI, and to notify you if there is a breach of your unsecured PHI. TriCore abides by the terms of the Notice currently in effect.
TriCore provides this Notice to you to describe the ways we may use and disclose your PHI, including how we may use your PHI within TriCore and how, under certain circumstances, we may disclose it outside TriCore. This Notice also describes the rights you have concerning your PHI.
If you have any questions about this Notice, or if you want to exercise any rights described in this Notice, please contact the Privacy Officer listed at the end of this Notice.
How We May Use and Disclose Your PHI
Treatment: We may use and disclose your PHI to provide you with the best laboratory service possible and for other treatment purposes. This may include communication with or a disclosure of your PHI to your health care provider (e.g., doctor, nurse, pharmacy) to clarify a laboratory test order or to provide test results.
Payment: We may use and disclose your PHI for billing and payment purposes. For example, we may provide PHI to your health plan so they will pay for our lab services.
Operations: We may use or disclose PHI for purposes of healthcare operations. These uses and disclosures may include the evaluation of the quality of our testing, the accuracy of results, securing accreditations, and for the operations and management of our lab. We may also disclose PHI to other healthcare providers or health plans involved in your care for their own operations, including coordination of care and benefits.
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 for permitted purposes. You may opt-out of the HIE though this link: https://www.syncronys.org/resources/#for-patients
TriCore Portals: TriCore hosts web-based portals that allow healthcare providers involved in your care or your health plan to access your PHI, including lab results, as permitted by law.
TriCore Provider Portal: To opt-out of the TriCore Provider Portal, you can electronically submit the opt-out form available here: www.tricore.org/optout or call 505-938-8922. You may opt-out at any time, but the opt-out will not apply to PHI accessed prior to opting-out. If you opt-out of the TriCore Provider Portal, healthcare providers involved in your care may have access to your PHI through other methods to the extent such access is permitted by law.
TriCore Payer Portal: TriCore hosts a TriCore Payer Portal so your health plan may access your PHI for operational purposes such as quality measure adherence, care coordination, and treatment authorization. When you pay TriCore out of pocket for lab services in full, you will be opted out of TriCore’s Payer Portal. To opt out of the TriCore Payer Portal: (i) do not present your insurance card at the time of specimen collection; and (ii) ask TriCore to bill you directly for the tests at the time of your collection at a TriCore draw site.
Individuals Involved in Your Care: TriCore may disclose PHI to family members, caregivers, or others involved in your care or payment for your care in certain circumstances. We may also use or disclose your PHI to notify a family member, personal representative, or another person responsible for your care, about your location, and general condition or to disaster-relief organizations so that family or persons responsible for your care can be notified about your condition, status, and location. NOTE: If you do not want us to disclose your PHI to a family member or friend involved in your care, you may contact the Privacy Officer listed at the end of this Notice.
Required by Law: We may use and share PHI if we are required to do so by law but only to the extent required.
Public Health and Safety: TriCore may share your health information for certain public health and safety activities such as: helping state or federal officials in preventing or controlling disease, injury, or disability; helping with product recalls; reporting adverse events; assisting employers and schools in limited circumstances; reporting suspected abuse, neglect, or domestic violence, or preventing or reducing a serious threat to anyone’s health or safety.
Employers: TriCore may disclose limited PHI to your employer if we perform lab testing at the request of the employer and the testing relates to medical surveillance of the workplace or whether you have a work-related illness or injury.
Health Oversight: We may disclose PHI to health oversight agencies for certain authorized review activities, such as audits, inspections, licensure or disciplinary actions or other activities necessary for the oversight of the health care system or government benefit programs. Health oversight agencies include without limitation the U.S. Department of Health and Human Services (HHS), the Centers for Medicare and Medicaid Services (CMS), and the New Mexico Human Services Department (HSD).
Judicial or Administrative Proceedings: TriCore may be required to release PHI in response to a court or administrative order, subpoena, discovery request, or other lawful process so long as certain conditions are met.
Law Enforcement or Other Government Functions: TriCore may share PHI with a law enforcement official or a correctional institution in certain circumstances or for special government functions such as military, national security, and presidential protective services.
Coroners, Medical Examiners, or Funeral Directors: TriCore may share PHI with a coroner, medical examiner, or funeral director when an individual dies.
Organ and Tissue Donation: We may share PHI organizations that obtain, store, or transplant human organs and tissues.
Research: We may use or share your information for research purposes but only if certain conditions are met.
Workers Compensation: We can share information about you as authorized by workers’ compensation laws or other laws that provide benefits to workers.
Incidental: Incidental uses and disclosures may occur during the course of providing laboratory services or in connection with an otherwise permitted use or disclosure.
You Must Authorize Other Uses and Disclosures
We will not use or disclose your PHI for a purpose not described in this Notice unless we have your written authorization. For example, we will not sell your PHI or use your PHI for most marketing purposes without your written consent.
TriCore’s authorization form is available at www.tricore.org/patients. If you authorize us to use or disclose your PHI and then change your mind, you may revoke your authorization at any time by sending a written request to our Privacy Officer listed at the end of this Notice. However, your revocation will not apply to any use or disclosure we already made.
Certain types of PHI may have additional protection under federal or state law. For example, PHI about mental health, HIV, sexually transmitted diseases, and genetic testing results may be treated differently under certain state laws. We will abide by any applicable privacy laws when using and disclosing your health information.
Access: You can ask to see or obtain an electronic or paper copy of your medical record and other health information that we maintain about you. You may also ask us to send a copy of your health information to other individuals or entities that you designate in writing. You may request access by visiting https://www.tricore.org/patients/getting-results/, contacting the Client Engagement Center at 505-938-8922. We may charge you a reasonable, cost-based fee to the extent permitted by law.
Amend: If you believe your PHI is incorrect or incomplete, you may ask TriCore to amend, update, or modify your PHI by submitting a written request to the Privacy Officer listed at the end of this Notice. Your request may be denied if the PHI was not created by TriCore or if the PHI is found to be accurate and complete.
Confidential Communications: You may ask us to communicate with you in a specific way or to send mail to a different address by contacting the Privacy Officer listed at the end of this notice. We will agree to all reasonable requests. NOTE: If you ask or agree to communicate with us through e-mail, text/SMS message, or other electronic means, those communications may not be secure, and your PHI could be intercepted by unauthorized third parties.
Restrictions: You may ask TriCore to restrict or limit its use or disclosure of your PHI for treatment, payment, or health care operations by contacting the Client Engagement Center at 505-938-8922 or submitting a written request to the Privacy Officer listed at the end of this Notice. While we will consider your written request, we may not be able to agree to such a restriction or limitation. If you pay for a service out-of-pocket in full and ask us not to share information about that service with your health plan, we will agree to such a restriction unless we are legally required to share that information. This process only applies when TriCore performs the billing for your lab services. If your tests are ordered by a provider that bills for the test, you should direct this request to the ordering provider.
Accounting of Disclosures: You can submit a written request to the Privacy Officer listed below if you would like a list of certain disclosures we made of your PHI. Your request must specify the time period. If you request such a list more than once a year, we may charge a reasonable, cost-based fee.
Copy of this Notice: You can ask for a paper copy of this Notice at any time.
Questions, Concerns, or Complaints
If you have any questions, concerns, or complaints about our privacy practices, please contact TriCore’s Privacy Officer at 1001 Woodward Place N.E., Albuquerque, NM 87102 or 505-938-8330 or firstname.lastname@example.org.
You may also file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights at 200 Independence Avenue, S.W., Washington, D.C. 20201 or through www.hhs.gov/hipaa/filing-a-complaint
TriCore will not retaliate against you for filing a complaint.
Changes to the Terms of this Notice
TriCore reserves the right to change the terms of this Notice and apply the changes to all PHI maintained by TriCore. The current Notice is available upon request at any TriCore facility, and on the TriCore website: www.tricore.org.
Effective date: August 1, 2023