HIPAA Privacy Practices and Forms

Independence Administrators is committed to protecting the privacy of our customers’ personal health information. As a Business Associate, part of that commitment is complying with the Privacy Rule of the Health Insurance Portability and Accountability Act of 1996 (HIPAA), which requires us to take additional measures to protect personal information and to inform our customers about those measures.

General HIPAA Information

• HIPAA Compliance
• How to Retrieve Secure Email from Independence Administrators

HIPAA Privacy Forms

For your convenience, download and print any of the following HIPAA forms as needed:

• Authorization to Release Information
• Request for Copies of PHI
• Request for Confidential Communication of PHI
• Request for Limitations and Restrictions of PHI
• Amendment Request
• Revocation of Access
• Request for Accounting of Disclosures of PHI
• Personal Representative Request

Mail or fax the completed and signed forms to:

Independence Administrators
Attn: Privacy Office
602 Office Center Drive, Suite 350
Fort Washington, PA 19034
Fax: 215-238-7993
Phone: 215-830-2579

HIPAA Transactions for Providers

For information about HIPAA-compliant transactions, visit the Electronic Data Interchange (EDI) Services section.

HIPAA Privacy Inquiries

If you have questions or comments regarding HIPAA Privacy, please submit an inquiry.