Wis. Admin. Code Office of the Commissioner of Insurance § Ins 17.275 - Claims information; confidentiality

Current through March 28, 2022

(1) PURPOSE. This section interprets ss. 19.35(1) (a), 19.85(1) (f), 146.82, 655.26 and 655.27(4) (b), Stats.
(2) OPEN RECORDS; PRIVILEGED OR CONFIDENTIAL FUND RECORDS. Except as provided in s. 601.427(7), Stats., records of the fund are subject to subch. II, Stats., and are open to inspection as required under subch. II, Stats. The fund may withhold and retain as confidential any record which may be withheld and retained as confidential under subch. II, Stats., including, but not limited to, a record which may be withheld or which is privileged under any law or the rules of evidence, as attorney work product under the rules of civil procedure, as attorney-client privileged material under s. 905.03, Stats., as a medical record under ss. 146.81 to 146.84, Stats., or as privileged under s. 601.465, Stats.
(3) DEFINITION. In this section, "confidential claims information" means any document or information relating to a claim against a plan-insured health care provider in the possession of the commissioner, the board or an agent thereof, including claims records of the plan.
(4) DISCLOSURE. Confidential claims information may be disclosed only as follows:
(a) To the medical examining board as provided under s. 655.26, Stats.
(b) As needed by the peer review council, consultants and the board under s. 655.275, Stats., and rules promulgated under that section.
(c) As provided under s. 804.01, Stats.
(d) To an individual, organization or agency required by law or designated by the commissioner or board to conduct a management or financial audit.
(e) With a written authorization from the plan-insured health care provider on whose behalf the claim was defended or paid.
(f) To the risk manager for the fund, as needed to perform the duties specified in its contract. The risk manager may not disclose confidential claims information to any 3rd party, unless the board expressly authorizes the disclosure. The board may authorize disclosure of patient health care records subject to ss. 146.81 to 146.84, Stats., only as provided in those sections.

Notes

Wis. Admin. Code Office of the Commissioner of Insurance § Ins 17.275
Cr. Register, March, 1988, No. 387, eff. 4-1-88; cr. (3) (e), Register, June, 1990, No. 414, eff. 7-1-90; cr. (3) (f), Register, May, 1995, No. 473, eff. 6-1-95; am., Register, September, 1999, No. 525, eff. 10-1-99.

See the table of Appellate Court Citations for Wisconsin appellate cases citing s. Ins 17.275.

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