SYSTEM OF RECORDS NOTICES (SORNs)

DoD COMPONENT NOTICES

Department of the Navy

SYSTEM NAME:

Health Care Accounts and Insurance Information (June 16, 2003, 68 FR 35657).

SYSTEM LOCATION:

Primary System is located at the Bureau of Medicine and Surgery, 2300 E Street, NW, Washington, DC 20372-5300.

Decentralized Segments are located at the Naval Hospitals and Medical Clinics which provide services or perform work giving rise to such accounts receivable. Official mailing addresses are published as an appendix to the Navy's compilation of system of record notices.

CATEGORIES OF INDIVIDUALS COVERED BY THE SYSTEM:

Any individual receiving health care treatment or examination services funded by the Navy Medical Department. Coverage also includes sponsors and other persons responsible for the debts of such persons. All commercial insurance carriers with whom the Department of the Navy has filed a claim under the Third Party Payers Act.

CATEGORIES OF RECORDS IN THE SYSTEM:

Individual's name and Social Security Number, sponsor's Social Security Number, if applicable, pay grade, branch of service of service, duty station address, account number, activity performing service, patient's insurance information, civilian employer, patient category, time and dates of service, units of service, physicians' and hospitals' statements of service a total charges for treatment including interest, administrative and penalty charges, payment receipts, admission documents, correspondence relating to collection attempts to ascertain eligibility status, patient category, and third party insurer liability, records of payment received and outstanding balances, letter reports of uncollectible accounts receivable, records suspending or terminating collection action or effecting compromise settlement agreements, and requests for recovery of CHAMPUS funds and substantiating documents.

AUTHORITY FOR MAINTENANCE OF THE SYSTEM:

31 U.S.C. 191-195, 227, and 952 (also known as the Federal Claims Collection Act of 1966); 10 U.S.C. 1078-1079 and 1095; 37 U.S.C. 702, 705, and 1007; E.O. 9397 (SSN); and, 10 U.S.C. 1095, Collection From Third Party Payers Act.

PURPOSE(S):

To identify and facilitate payment of amounts owed the U.S. Users of the information include Bureau of Medicine and Surgery personnel who are directly involved in processing payments or billings of patient accounts. The information is used to determine amounts owed, methods to be employed to effect recovery, whether or not the claim can be compromised or collection action thereon terminated or suspended.

To determine amounts owed by third party health insurers, and to collect charges for utility bills and other miscellaneous items. File may be forwarded to the Naval Criminal Investigative Service for investigation or to any component of DoD, as needed, in the performance of their duties related to same.

ROUTINE USES OF RECORDS MAINTAINED IN THE SYSTEM, INCLUDING CATEGORIES OF USERS AND THE PURPOSES OF SUCH USES:

In addition to those disclosures generally permitted under 5 U.S.C. 552a(b) of the Privacy Act, these records or information contained therein may specifically be disclosed outside the DoD as a routine use pursuant to 5 U.S.C. 552a(b)(3) as follows

To third parties in those cases where the Government is seeking reimbursement under the Third Party Payers Act.

The DoD 'Blanket Routine Uses' that appear at the beginning of the Navy's compilation of systems notices also apply to this system.

NOTE This system of records contains individually identifiable health information. The DoD Health Information Privacy Regulation (DoD 6025.18-R) issued pursuant to the Health Insurance Portability and Accountability Act of 1996, applies to most such health information. DoD 6025.18-R may place additional procedural requirements on the uses and disclosures of such information beyond those found in the Privacy Act of 1974 or mentioned in this system of records notice.

Disclosure to consumer reporting agencies

Disclosure pursuant to 5 U.S.C. 552a(b)(12) may be made from this system to consumer reporting agencies as defined in the Fair Credit Reporting Act of 1966 (15 U.S.C. 1681a(f)) or the Federal Claims Collection Act of 1966 (31 U.S.C. 3701(a)(3)). The disclosure is limited to information necessary to establish the identity of the individual, including name, address, and taxpayer identification number (Social Security Number); the amount, status, and history of the claim; and the agency or program under which the claim arose for the sole purpose of allowing the consumer reporting agency to prepare a commercial credit report.

POLICIES AND PRACTICES FOR STORING, RETRIEVING, ACCESSING, RETAINING, AND DISPOSING OF RECORDS IN THE SYSTEM:

STORAGE:

Automated records stored on disc, tape, punched cards, and machine listings. Manual records stored on index cards (3x5) in card files and in file folders and reading files.

RETRIEVABILITY:

Automated records are retrieved by either a query or a request for a standard report. Data may be indexed by any data element although the primary search keys are name and Social Security Number. Paper records are filed alphabetically by last name of debtor.

Safeguards:

Access to the automated system requires user account number and password sign on. Access to the paper records and/or terminals are limited to authorized personnel that are properly screened and trained. Office space where records and/or terminals are located is locked after official working hours.

RETENTION AND DISPOSAL:

Records are retained in active file until collection action has been completed, compromised, suspended, or terminated. They are held in inactive file until statute of limitations has run and then destroyed.

System Manager(s) and Address:

Chief, Bureau of Medicine and Surgery, 2300 E Street, NW, Washington, DC 20372-5300, and Commanding Officers of Medical Treatment Facilities. Official mailing addresses are published as an appendix to Navy's compilation of system of record notices.

Notification Procedure:

Individuals seeking to determine whether this system of records contains information about themselves should address written inquiries to the Chief, Bureau of Medicine and Surgery, 2300 E Street, NW, Washington, DC 20372-5300 or to the Commanding Officer of the Medical Treatment Facility where treatment was received. Requests should provide the full name of the patient and sponsor, the military or dependency status of the patient and sponsor, and the location and approximate dates of treatment or examination. Driver's license and/or military I.D. card will be considered adequate proof of identity.

Record Access Procedures:

Individuals seeking access to records about themselves contained in this system of records should address written inquiries to the Chief, Bureau of Medicine and Surgery, 2300 E Street, NW, Washington, DC 20372-5300 or to the Commanding Officer of the Medical Treatment Facility where treatment was received. Requests should provide the full name of the patient and sponsor, the military or dependency status of the patient and sponsor, and the location and approximate dates of treatment or examination. Driver's license and/or military I.D. card will be considered adequate proof of identity.

Contesting Record Procedures:

The Navy's rules for accessing records, and for contesting contents and appealing initial agency determinations are published in Secretary of the Navy Instruction 5211.5; 32 CFR part 701; or may be obtained from the system manager.

Record Source Categories:

Automated patient administration system records produced at Medical Treatment Facilities include but are not limited to Inpatient Admission/Disposition Records, NAVMEDCOM 6300/5; Report of Treatment Furnished Pay, Patients-Hospitalization/Outpatient Treatment Furnished, DoD 7/7A, Part A/B. Other

Record Source Categories:

are OCHAMPUS, Denver; U.S. Postal Service; Military Locator Service; State Departments of Motor Vehicles; any component of the DoD; the Department of Justice, the General Accounting Office, retail credit associations, financial institutions, current or previous employers, educational institutions, trade associations, automated system interfaces, local law enforcement agencies, the Department of Health and Human Services, the Internal Revenue Service, and the Office of Personnel Management.

Exemptions Claimed for the System:

None.