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Carelon Behavioral Health Strategies, LLC
EDI GATEWAY
TERMS OF USE
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| Introduction |
Carelon Behavioral Health is making the services on the EDI Gateway available to you as an authorized representative
("User" or "You") of a health care provider, business associate or vendor who has rendered services
to the members of the health plans Carelon Behavioral Health provides behavioral health services. In using this service,
you may be allowed access to certain confidential or individually identifiable protected health
information (hereinafter "Protected Health Information"). In exchange for such access, you agree
to take certain precautions, comply with certain practices, and implement certain procedures required
by applicable law and Carelon Behavioral Health for the purposes of guarding data integrity and safeguarding the confidentiality
of Protected Health Information,
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| User's Responsibilities and Obligations |
- By registering herein, you agree that you have
the legal authority, right and ability to agree to these “EDI Gateway”
terms of use and that you will use bhsedi.carelonbehavioralhealth.com in a manner
consistent with the terms of use. You represent that you have the right
to access information about the health plan members as the treating
provider or his/her designee. You further agree that you will comply
with all applicable laws and regulations and that you will maintain the
confidentiality of any information you access through this website. You
agree that you will protect the integrity, confidentiality and
availability of all electronically transmitted or electronically
maintained protected health information exchanged through this website
as required by any applicable laws or regulations.
- The required edits, minimum submission
standards, the EDI Transactions / Billing Intermediary Authorization
form must be fulfilled and maintained by all providers and billing
agencies submitting EDI transactions to Carelon Behavioral Health.
- The individual provider is ultimately
responsible for accuracy and valid reporting of all claims submitted for
payment. A provider utilizing the services of a billing agency must
ensure through legal contract (a copy of which must be made available to
Carelon Behavioral Health upon request) the responsibility of a billing service to report
claim information as directed by the provider in compliance with all
policies stated by Carelon Behavioral Health.
- You agree to use Protected Health Information
for claims administration purposes only, consistent with applicable
laws.
- You agree not to use or further disclose
Protected Health Information in a manner that, if undertaken by Carelon Behavioral Health,
would violate the requirements of the HIPAA Privacy Regulations.
- You agree to not use or further disclose
protected health information other than as permitted or required by this
Agreement. You agree to use appropriate safeguards to prevent any use or
disclosure of Protected Health Information that is not permitted under
applicable law.
- Your user name and password are intended to
protect your privacy and the protected health information of the health
plan’s members and yourself. You are responsible for keeping your user
name and password confidential and you hereby agree that you will not
disclose your user name or password to others. You agree that you will
be solely responsible for all activity or transactions that are tracked
to your user name and password through this web site.
- You acknowledge that you are acting as an independent contractor,
and you are not an agent of Carelon Behavioral Health and have no authority to represent
Carelon Behavioral Health as to any matters.
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| Changes, Updates, Governing Law |
These terms of use may change from time to time, and changes will be posted here so that
you will always be aware of our terms of use. By using the “EDI Gateway” at bhsedi.beaconhs.com
or doing any of the activities described above after changes have been made to these terms of use,
you are agreeing to accept these changes. You may not amend or modify these terms of use without
prior written agreement from Carelon Behavioral Health. The laws of the Commonwealth of Massachusetts shall govern
these terms of use. You agree to submit to the exclusive jurisdiction of the courts in the Commonwealth
of Massachusetts and waive any jurisdictional venue or inconvenient forum objections to such court.
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| Termination |
Carelon Behavioral Health may terminate these terms of use, any rights granted to you hereunder and your access to this
web site at any time, with or without cause, without notice and without penalty. It is the contracted
provider’s responsibility to inform Carelon Behavioral Health of any changes in employee status of staff members who have
a submitter ID and password.
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| Unauthorized Use/Misuse |
Unauthorized entry (commonly referred to as hacking) into any portion of bhsedi.beaconhs.com,
or misuse (for fraudulent, malicious and/or deceptive purposes) may constitute crimes or torts
under state or federal law. Any such violations will be pursued and prosecuted to the fullest
extent permitted by law.
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