This BUSINESS ASSOCIATE Agreement, pursuant to Final Rules and Regulations of HIPAA, expresses the obligations of confidentiality of both parties in the handling of Protected HealthCare Information is made on (date)___________________________, by and between _____________________________________________________(your business name), a COVERED ENTITY, and JetClaims Clearinghouse, a BUSINESS ASSOCIATE, located at 861 E. Klosterman Rd, #130, Tarpon Springs, FL 34689..
The COVERED ENTITY has entered into a BUSINESS ASSOCIATE Agreement with the BUSINESS ASSOCIATE. Under the Agreement, the BUSINESS ASSOCIATE may have access to Private Health Information. The purpose of this Agreement is to ensure the BUSINESS ASSOCIATE properly uses and/or discloses the Private Health Information in accordance with the Privacy Rule, as defined in the Health Insurance Portability and Accountability Act of 1996.
Now therefore, in exchange for the mutual promises contained herein, the parties agree as follows:
1. DEFINITIONS
a. “Individual shall have the same meaning as the term “individual” in CFR 164.501 and shall include persons who qualify as a personal representative in accordance with 45 CFR 164.502(g).
b. “Privacy Rule” shall mean the Standards for Privacy of Individually Identifiable Health Information at 45 CFR Part 160 and Part 164, Subparts A and E.
c. “Protected Health Information” (PHI) shall have the same meaning as the term “protected health information” in 45 CFR 164.501, limited to the information created or received by BUSINESS ASSOCIATE from or on behalf of COVERED ENTITY.
d. “Required by Law” shall have the same meaning as the term “Required by Law” in 45 CFR 164.501.
e. “Secretary” shall mean the Secretary of the Dept of Health and Human Services or his designee.
2. BUSINESS ASSOCIATE OBLIGATIONS
a. The BUSINESS ASSOCIATE may use or disclose PHI to perform functions, activities or services for, or on behalf of, COVERED ENTITY as specified in the Agreement, provided that the use or disclosure would not violate the Privacy Rule if done by the COVERED ENTITY or the minimum necessary policies and procedures of the COVERED ENTITY.
b. The BUSINESS ASSOCIATE may use PHI to provide Data Aggregation services to COVERED ENTITY as permitted by the Privacy Rule.
c. The BUSINESS ASSOCIATE may use PHI for the proper management and administration of the BUSINESS ASSOCIATE or to carryout the legal responsibilities of the BUSINESS ASSOCIATE.
d. The BUSINESS ASSOCIATE agrees not to use or disclose PHI other than as permitted or required by the Agreement or as Required by Law.
e. The BUSINESS ASSOCIATE agrees to use appropriate safeguards to prevent use of disclosure of the PHI other than as provided by this Agreement.
f. The BUSINESS ASSOCIATE agrees to report to COVERED ENTITY any use or disclosure of the PHI not provided for by this Agreement of which it becomes aware.
g. The BUSINESS ASSOCIATE agrees to ensure that any agent, including a subcontractor, to whom it provides PHI received from, or created or received by BUSINESS ASSOCIATE on behalf of COVERED ENTITY agrees to the same restrictions and conditions that apply through this Agreement to BUSINESS ASSOCIATE with respect to such information.
h. The BUSINESS ASSOCIATE agrees to provide access to PHI in accordance with 45CFR 164.524.
i. The BUSINESS ASSOCIATE agrees to make available the PHI for amendment and incorporate any amendments to the PHI that the COVERED ENTITY directs or agrees to pursuant to 45 CFR 164.526 at the request of COVERED ENTITY or an Individual.
j. The BUSINESS ASSOCIATE agrees to make internal practices, books, and records, including policies and procedures and PHI, relating to the use and disclosure of PHI received from, or created or received by BUSINESS ASSOCIATE on behalf of COVERED ENTITY, available to Secretary for purposes of determining the COVERED ENTITY is in compliance with the Privacy Rule.
k. The BUSINESS ASSOCIATE agrees to document such disclosures of PHI and information related to such disclosures as would be required for COVERED ENTITY to respond to a request by an Individual for an accounting of disclosures of PHI in accordance with 45 CFR 164.528.
l. The BUSINESS ASSOCIATE agrees to provide COVERED ENTITY or an Individual information collected in accordance with the Agreement to permit the COVERED ENTITY to respond to a request by an Individual for an accounting of disclosures of PHI in accordance with 45 CFR 164.528.
m. The BUSINESS ASSOCIATE may disclose PHI for the proper management and administration of the BUSINESS ASSOCIATE, provided that disclosures are Required by Law, or BUSINESS ASSOCIATE obtains reasonable assurances from the person to whom the information is disclosed that it will remain confidential and used or further disclosed only as Required by Law or for the purpose for which it was disclosed to the person, and the person notifies the BUSINESS ASSOCIATE of any instances of which it is aware in which the confidentiality of the information has been breached.
n. The BUSINESS ASSOCIATE may use PHI to report violations of law to appropriate Federal and State authorities, consistent with 45 CFR 1643502(j)(1).
3. COVERED ENTITY OBLIGATIONS
a. COVERED ENTITY shall notify BUSINESS ASSOCIATE of any limitation(s) in its notice or privacy practices of COVERED ENTITY in accordance with 45 CFR 165.520, to the extent that such limitation may affect BUSINESS ASSOCIATE use or disclosure of PHI.
b. COVERED ENTITY shall notify BUSINESS ASSOCIATE of any changes in, or revocation of, permission by Individual to use or disclose PHI, to the extent that such changes may affect BUSINESS ASSOCIATE use or disclosure of PHI.
c. COVERED ENTITY shall notify BUSINESS ASSOCIATE of any restriction to the use or disclosure of PHI that COVERED ENTITY has agreed to in accordance with 45 CFR 164.522, to the extent that such restriction may affect BUSINESS ASSOCIATE use or disclosure of PHI.
4. TERM AND TERMINATION
a. The Term of this Agreement shall be effective on the date first above written and shall terminate when all of the PHI provided by COVERED ENTITY to BUSINESS ASSOCIATE, or created or received by BUSINESS ASSOCIATE on behalf of COVERED ENTITY, is destroyed or returned to COVERED ENTITY, or, if it is not feasible to return or destroy PHI, protections are extended to such information in accordance with the termination provisions in this sections.
b. Upon COVERED ENTITY knowledge of a material breach by BUSINESS ASSOCIATE, COVERED ENTITY shall immediately terminate this Agreement. If neither termination nor cure are feasible, the COVERED ENTITY shall report the violation to the Secretary.
c. Upon termination of this Agreement, for any reason, BUSINESS ASSOCIATE shall return or destroy all PHI received from COVERED ENTITY, or created or received by BUSINESS ASSOCIATE on behalf of COVERED ENTITY. This provision shall apply to PHI that is in the possession of subAgreementors or agents of BUSINESS ASSOCIATE. BUSINESS ASSOCIATE shall retain no copies of the PHI.
d. In the event that BUSINESS ASSOCIATE determines that returning or destroying the PHI is not feasible, BUSINESS ASSOCIATE shall provide to COVERED ENTITY notification of the conditions that make return or destruction infeasible. Upon agreement with COVERED ENTITY that return or destruction of PHI is infeasible, BUSINESS ASSOCIATE shall extend the protections of this Agreement to such PHI and limit further uses and disclosures of such PHI to those purposes that make the return or destruction infeasible, for so along as BUSINESS ASSOCIATE maintains such PHI.
5. MISCELLANEOUS
a. A reference in this Agreement to a section in the Privacy Rule means the section as in effect or as amended.
b. The parties agree to take such action as is necessary to amend this Agreement from time to time as is necessary for COVERED ENTITY to comply with the requirements of the Privacy Rule and the Health Insurance Portability and Accountability Act of 1996, Pub. L., No 104-191.
c. Any ambiguity in this Agreement shall be resolved to permit COVERED ENTITY to comply with the Privacy Rule.
This Agreement was signed by the parties, and is effective on the date first above written.
COVERED ENTITY BUSINESS ASSOCIATE
By: __________________________________ By: ______________________________________
Print Name:___________________________ Print Name: John Brnich
Title:________________________________ Title: Operations Manager
Fax to: 727.938.3853