9-Data Sharing Assessment v2.docx
DOCX document 29 KB Posted
- Attached to
- Clinical Review Services
- Solicitation number
- 25-06803
- Issued by
- San Bernardino County, California
About this file
This is a Data Sharing Assessment Form for Inland Empire Health Plan (IEHP), a California-based health plan organization, in connection with the Clinical Review Services contract opportunity. The form serves as a comprehensive intake document designed to evaluate vendor compliance and data security protocols for third-party service providers and vendors supporting IEHP's operations. The assessment captures critical information including vendor contact details, service descriptions, data transmission methods, and workforce composition, with particular attention to whether vendors utilize offshore resources or subcontractors that could impact data handling practices.
The form identifies the specific categories of sensitive information that vendors may access, handle, or disclose, including personally identifiable information (PII) such as full names, addresses, dates of birth, social security numbers, driver's license numbers, and member health plan ID numbers, as well as medical and behavioral health information including diagnoses, treatment records, prescriptions, claims data, and healthcare payment information. The assessment requires vendors to specify the scope of data exposure by identifying whether information pertains to IEHP staff, IEHP team members, IEHP members, or providers, and to quantify the approximate number of individuals whose information will be shared. This document functions as a mandatory due diligence mechanism to ensure vendors meet IEHP's regulatory requirements and security standards for handling protected health information in support of clinical review services for prior authorizations, grievances, and quality incident management.
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Text version
Section A: IEHP Contact Information
IEHP Department(s) Using Service or Vendor
IEHP Point of Contact Name
IEHP Point of Contact Title
IEHP Point of Contact Extension
Section B: 3rd Party / Vendor Contact Information
Company Name:
Company Address:
Company Web Site:
Primary Contact Name:
Primary Contact phone number:
Primary Contact email address:
Estimated Start Date
Estimated End Date
Section C: Services Provided to IEHP (Please give detailed explanation)
Section D: How is/ will sensitive information be transmitted, received, created/ maintained between IEHP & 3rd Party/ Vendor? (Please give detailed explanation)
Section E: Will 3rd party/ Vendor use offshore resources/ subcontractor(s)/ have a global workforce? If Yes, please explain in detail regarding country/ countries & services that require this.
IEHP Da t a Sha r ing Ass e ssment F o r m
Section F: Identify the types of information that will be received, viewed, used, disclosed or handled by vendor
Personally Identifiable Information (PII)
WHO IS THE DATA ABOUT?
| IEHP |
| IEHP Team |
| IEHP |
| Members |
| Members |
| Providers |
Full first name
Full last name
Complete addresses smaller than a state
Date of Birth
Phone numbers
Fax numbers
Email addresses
Social Security numbers
Member health plan ID number
Banking or Financial accounts
Driver’s License numbers
Vehicle identifiers and serial numbers, including license plate numbers
Individual's Website URLs
Internet Protocol (IP) address numbers
Biometric identifiers, including finger, retinal and voice prints
Full face photographic images
Any other unique number characteristic or code directly related to an individual not listed above
Medical or Behavioral Health Information
WHO IS THE DATA ABOUT?
IEHP
IEHP Team Members
Members
Medical information including diagnosis, admission \ discharge dates, healthcare treatment, medical history, medical records, etc.
Prescriptions
Healthcare payment information including claims, bills, receipts and explanation of benefits
Ancillary services including x-rays and labs
Data or information related to the provision of health care to an individual not listed above
Section G: Number of persons information being shared Approximate number of persons whose information will be viewed, used, disclosed or handled
File details come from the government source that posted it. Updated .