How would a covered entity or health information organization (HIO), acting on its behalf, know if someone were a personal representative for the purpose of granting access under the HIPAA Privacy Rule?

The Privacy Rule’s verification standard requires that covered entities develop and implement reasonable policies and procedures to verify the identity and authority of such persons, if otherwise unknown to them, before granting them access to protected health information (PHI). See 45 C.F.R. § 164.514(h). Once verified, the personal representative can then be given the appropriate credentials for authentication and access through an electronic system. The Privacy Rule allows covered entities to rely on their professional judgment, as well as industry standards, in designing reasonable verification and authentication processes.
The Privacy Rule permits a covered entity to assign this function to a HIO, acting as its business associate, so long as the relevant standards are complied with. For example, a covered entity could use the HIO to assign the appropriate credentials and authenticate personal representatives, and any others, seeking access to PHI.

Created 12/15/08