Claims story: Handle Protected Health Information (hashtag#PHI) with Care

Claims story: Handle Protected Health Information (hashtag#PHI) with Care 

Patient claims data includes medical conditions, procedures, and prescriptions, generated when healthcare providers submit payment requests to health plans. This data is widely used in commercial analytics for identifying patient cohorts, patient journeys, and market potential.

However, it also contains personal information that analysts must not access. You can use birthdates to calculate patient ages for analysis, but do not share the birthdates. Similarly, you can use patient zip codes to show data by state or city, but do not share individual zip codes.

The Health Insurance Portability and Accountability Act (hashtag#HIPAA) of 1996 regulates the use of PHI in the United States. HIPAA oversees how this data is collected, created, received, transmitted, maintained, and stored by any HIPAA-covered organization.

The following 18 patient identifiers should not be used or shared with clients or anyone else:

1-3: Patient Name, ZIP Code, Birth year

4-6: Phone number / Fax number / Email address

7-11: Social Security, Medical record, Health plan beneficiary, Account, & Certificate number

12-13: Vehicle license plate numbers, Device identifiers and serial numbers.

14-15: Web URL, Internet Protocol address.

16-18: Biometric identifiers, such as a fingerprint or voice print, Full-face photographs and other photos of identifying characteristics.

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