Partners Tailored Plan Provider Portal Set Up Form |
ProviderCONNECT
To access ProviderCONNECT, in-network contracted providers must identify one individual who will serve as their Local Administrator and will be responsible for managing all other users who access Partners’ ProviderCONNECT for that provider organization.
To maintain the integrity of the provider portal and ensure only appropriate individuals have access to provider information inside the portal, this form must be signed by the CEO of the agency/practice associated with the tax id number indicated on this form.
“Provider’s Privacy/Security Officer shall investigate and mitigate, any known or suspected breach of this Agreement by Providers designated employees, owners, and directors. Further, Privacy/Security Officer shall promptly notify Partners of: (i) any actual or suspected Breach as defined by 45 CFR 164.402, or any actual or suspected security incident including any attempted or actual exploit or vulnerability such as phishing, malware, distributed denial of service attack, or other event that may or could adversely impact the security, integrity or availability of the PHI, of which Officer becomes aware, or any other confidentiality, privacy or security claim or complaint, arising out of, or relating to or otherwise connected with the Partners Member records accessed or used by Provider; (ii) any subpoena, demand, request, or other inquiry from any governmental or regulatory entity made to the Provider, arising out of, in connection with or otherwise relating to this Agreement; (iii) any suspension or separation from provider’s employment of any employee granted access to the Portal; (iv) any change in the employee’s job duties that alter or terminate such access to the Portal or member records.
Health Insurance Portability & Accountability Act of 1996 (“HIPAA”). Provider explicitly acknowledges and understands that it is required to comply with any and all laws relating to privacy and/or security of protected health information (“PHI”) or other healthcare, public assistance or social services information, including but not limited to HIPAA and its implementing regulations, 45 CFR Parts 160, 162 & 164, as further expanded by the Health Information Technology for Economic and Clinical Health Act (HITECH Act), which was adopted as part of the American Recovery and Reinvestment Act of 2009, commonly known as “ARRA” (Public Law 111-5) and any subsequent modifications thereof, the Substance Abuse Confidentiality regulations set forth in 42 CFR Part 2, N.C.G.S. § 122C-51, et seq., N.C.G.S. § 108A-80,10A NCAC Subchapter 26B, and DMH/DD/SAS Confidentiality Rules published as APSM 45-1 (effective January 2005).”
Designated portal administrators must complete the form below, include your Chief Executive Officer’s/authorized contract signature, and submit.