Verification Tips

While it is of utmost importance that a person’s identity be verified, the verification process must be conducted in a customer friendly fashion. Any uncertainties regarding person verification should be handled courteously, for example, “I would be more than happy to assist you with your request Mr. Jones. Let me research your request further and contact you shortly. How can I best reach you?”

For callers that identify themselves as the patient or patient’s legal representative:

At the beginning of the call or inquiry establish the person’s identity:

Standard verification procedures include asking for the caller to provide information (1) that is documented in our system or chart and (2) that only the patient or patient’s legal representative would know, such as:

• Patient Address
• Patient Date of Birth
• Patient Social Security number
• Patient and/or Legal Representative Drivers License number (if, on file)

If uncertain as to whether the person is who he or she is, ask questions, as applicable, such as:

• Most recent service received
• When and where the lab/procedure was done
• Type of lab work/procedure calling about
• Name of treating physician

Tricky Issues:

• A spouse is usually not a legal representative and would require documentation noting that the spouse has permission to receive information on behalf of the patient.
• The parent of a pregnant minor or a minor that received testing for a sexually transmitted disease would not necessarily have the right to have information discussed with him or her about the minor patient. Obtain help from your supervisor in these cases.

For callers that identify themselves as someone other than the patient or patient’s legal representative:

At the beginning of the call or inquiry:

• Obtain name of person and if applicable, company or affiliation
• Obtain call back telephone number
• Obtain reason for call or inquiry

If an established business relationship with the person exists or if the person is documented in the system as having permission to receive certain information, follow your department protocol for responding. If unsure, get help from your supervisor. 

If there is not an established business relationship with the person, document the person’s request and pertinent contact information and kindly advise the person that either you or someone else will be contacting them shortly. Obtain assistance from your supervisor.

If the call or inquiry is from a government official, health oversight agency or other official agency, immediately route the call or inquiry to your supervisor for appropriate handling and response. Guidance for verification and establishing authority for requests from public officials is found under the Verification Requirements section.

For general questions on how information can be used or disclosed e.g., for payment or payer audits, as well as conditions for sharing information with entities such as Schools, Law Enforcement Officers, etc., see modules Using and Disclosing Health Information and Other Communications Under HIPAA. Refer to the Identity Verification Guidelines document for more information.