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Date ArticleType
2/6/2017 Payment/Reimbursement
Indiana Medicaid Requires Third Party Disclosure Authorization Forms

OMPP, in conjunction with Myers & Stauffer, has created a third party disclosure authorization form in an effort to achieve maximum privacy for IHCP members and providers. Click on the links for a memo and the form. Myers & Stauffer often receives requests from third parties - cost report preparers, accountants, attorneys, etc.  - that represent IHCP providers for information such as compliance review supporting workpapers, which may contain PHI, as well as cost profiles.  In order to ensure that Myers & Stauffer are releasing this protected information to the appropriate representatives, we ask that providers complete the attached third party disclosure authorization form in order for the third party to have access to ALL documents. 

This authorization form will be used for providers using the web portal as well as for providers that are not using the web portal, if they are utilizing a third party for their business interests. 

If you have questions about this form, you can contact Derris Harrison at Derris.Harrison@fssa.IN.gov.