3 . “ Operations :
• Certain quality improvement activities ( e . g ., care management and care coordination )
• Quality of care reviews in response to member and / or state / federal queries
• Response to member complaints / grievances
• Health Plan Employer Data and Information Set Reviews ( HEDIS )
• Legal activities ( e . g ., audit programs , FWA )
Providers are responsible for obtaining Hometown Health ’ s authorization for any necessary treatment beyond what was the member acquired through their enrollment process .
Members have the right to approve or deny release of their PHI for uses other than TPO .
In accordance with the HIPAA Enforcement and Breach Notification Rules , providers will promptly notify Hometown Health of any unlawful or unauthorized uses or disclosure of confidential or PHI regarding our members and will be subject to the provisions relating to compliance , investigations , and the imposition of civil money penalties for violations of the HIPAA Administrative Simplification Rules .
94