Protected Health Information

to be redacted when submitting a dispute to the Medical Payment Committee
An example of a medical document with Protected Health Information blocked out with a black box in various areas on the document.

When submitting a dispute to the Medical Payment Committee, a redacted copy of all the documents is required. This list, along with four additional items, should be redacted upon submission of Form C-47 to the Tennessee Bureau of Workers' Compensation.

Under the U.S. Health Insurance Portability and Accountability Act (HIPAA), PHI that is linked based on the following list of 18 identifiers must be treated with special care:

  1. Names
  2. All geographical identifiers smaller than a state, except for the initial three digits of a zip code if, according to the current publicly available data from the U.S. Bureau of the Census: the geographic unit formed by combining all zip codes with the same three initial digits contains more than 20,000 people; the initial three digits of a zip code for all such geographic units containing 20,000 or fewer people is changed to 000
  3. Dates (other than year) directly related to an individual
  4. Phone Numbers
  5. Fax numbers
  6. Email addresses
  7. Social Security numbers
  8. Medical record numbers
  9. Health insurance beneficiary numbers
  10. Account numbers
  11. Certificate/license numbers
  12. Vehicle identifiers and serial numbers, including license plate numbers;
  13. Device identifiers and serial numbers;
  14. Web Uniform Resource Locators (URLs)
  15. Internet Protocol (IP) address numbers
  16. Biometric identifiers, including finger, retinal and voice prints
  17. Full face photographic images and any comparable images
  18. Any other unique identifying number, characteristic, or code except the unique code assigned by the investigator to code the data.

For purposes of the Medical Payment Committee, the following also needs to be redacted:

  1. Claim number
  2. State file number
  3. Date of Injury
  4. Employer name and address