How does Milliman IntelliScript process electronic medical data for individual underwriting?
Milliman IntelliScript’s Irix system is similar to traditional methods for insurers to access medical records from a doctor, hospital, pharmacy or other medical facility. As part of its underwriting or claims process, a client (insurance company) sends Milliman IntelliScript an Authorized Request for electronic medical data for an individual. Within seconds, Milliman IntelliScript checks with its data sources to see if any information is available and then returns electronic medical data to the client for that individual.
What is an Authorized Request?
An Authorized Request is a request for an individual’s medical history including electronic medical records and prescription histories on behalf of an individual who has provided an authorization for the release of his/her information. The individual's authorization must comply with the Health Insurance Portability and Accountability Act (HIPAA). The authorization must specify, for example, what type of information is authorized to be disclosed, who is being authorized to disclose the information and who is authorized to receive the information. There are additional details required in the authorization, such as the individual’s signature (written, electronic or voice-recorded) and date signed.
Where does Milliman IntelliScript get its data?
When Milliman IntelliScript receives an Authorized Request, it passes the individual’s identifying information to its contracted data sources (for example: retail pharmacy chains, Pharmacy Benefit Managers or “PBM’s”, or health plans). Each data source returns any medical information that was authorized to be released. Milliman IntelliScript software organizes the responses from the data sources and presents the information to the user.
What is a Pharmacy Benefit Manager (PBM)?
A PBM is an entity that provides a broad range of pharmacy and prescription drug administration services. Most PBMs act as a pharmacy by providing prescription drugs via mail service. In addition, PBMs may provide prescription services for insurance companies, retail pharmacies, individual consumers and government programs. PBMs also invest significantly in research areas such as optimizing prescription therapy and improving consumer safety.
How do I get a copy of my electronic medical data report?
Individuals can request a copy of their report by contacting Milliman IntelliScript. A report will exist only if the individual authorized the release of his/her records to an insurance company and that company submitted a request to Milliman IntelliScript. Otherwise, Milliman IntelliScript will have no report/information. In some cases, no electronic medical data is found for the individual so the "report" would be blank. Click here to request a copy of your report.
How does Milliman protect consumer privacy?
Milliman IntelliScript operates under HIPAA, which establishes the requirements for the disclosure of Protected Health Information (PHI). These strict and comprehensive requirements are part of the legislation and are universally recognized throughout the insurance and healthcare industries. Milliman IntelliScript prides itself on our secure systems and state-of-the-art infrastructure that keeps consumer data confidential.
How do consumers benefit from electronic medical data?
Consumers benefit from faster decisions from the insurance company. Rather than waiting weeks or months for other medical records, medical claims records and prescription histories are fast–they can often enable an insurance company to make an underwriting decision the same day the applicant applies for coverage. Also, consumers benefit from lower underwriting costs, which helps reduce premiums; electronic medical data and prescription histories cost the insurer only a fraction of the cost of full medical records and can often eliminate the need for medical records, personal interviews, lab tests, and other costly and time-consuming underwriting processes.
How is the use of electronic medical data regulated?
Milliman IntelliScript operates in accordance with HIPAA, the Fair Credit Reporting Act (FCRA), and all other applicable laws and regulations. HIPAA brings comprehensive legislation to preserve individuals’ privacy in an era of digital communications. If an insurer makes an adverse decision (i.e., higher rate or decision to decline) based in whole or in part on electronic medical data, then the FCRA requires the insurer to notify the applicant. The notice must include the name, phone number and address for the company that supplied the report (i.e., Milliman IntelliScript). The notice also states that the recipient has a right to a free copy of the report and the right to dispute anything believed to be inaccurate. The FCRA and HIPAA bring comprehensive protection to consumers.
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