On March 9, 2020, the Centers for Medicare & Medicaid Services released the Interoperability and Patient Access final rule. Plans are required to implement a secure application programming interface (commonly known as an “API”) that gives members easy access to their health information.
Additionally, the CMS Interoperability and Prior Authorization final rule (CMS-0057-F) is effective January 1, 2027. This rule requires health plans to implement APIs to share member data with providers, support electronic medical prior authorization with providers, and exchange member information with recent and concurrent payers for coordination of benefits.
Across these two regulations, there are now multiple ways that you can access and share your health information. It is important that you understand your different options, including your ability to opt in and opt out, so that your health information is used to support your care in a way that feels comfortable for you.
Sharp Health Plan has created a Provider Access API that in-network providers can use to download your personal health information to assist with your treatment. The Provider Access API is a framework which allows a health plan to share information like claims, prior authorizations, and health history with health care providers to help them provide the best possible care for a patient's unique needs. You are included automatically, but you can opt out at any time.
Allowing your health care data to be shared with your provider can help them better coordinate your care, improve prior authorization processes, ensure you receive care in a timely manner, help you achieve better outcomes, and improve your overall health care experience.
Only in-network providers who are involved in your care.
Your information is protected by privacy and security safeguards, including any relevant federal, state, and tribal laws related to sensitive services.
You are included automatically. You can opt out at any time. You can also change your mind and opt back in at any time. Opting out does not affect your coverage or benefits.
Choosing to share your data gives your provider permission to access your health information. The timing may be different for each provider because health care organizations are adopting this technology at different rates. Some may not have access until on or after January 1, 2027.
Sharp Health Plan has created a Payer-to-Payer API that can be used to exchange your personal health information with recent and concurrent health plans and other payers. The Payer-to-Payer API is a framework that helps health plans access important information from a member's previous and concurrent health insurance providers, like claims, prior authorizations, and health history. You control whether we request your data from another health plan and can opt in at any time.
Opting into data sharing has several potential benefits, which could include better coordination of your care, improved completeness of your medical records if you change insurance carriers, reduction in care disruptions, improved continuity of care, better outcomes, and a better overall health care experience.
You control whether we request your health care data from your previous insurer or exchange data with your concurrent insurer(s) through the API and can “opt in” at any time. This means your data is not shared through the API automatically – you decide when and if API data sharing is allowed.
If you “opt in” to having your data shared with other insurers through the API, you can opt back out again at any time. Opting out does not affect your coverage or benefits.
Once we have your permission, we will attempt to retrieve your information from the other health insurance plan. Health plans may adopt this technology at different rates, and it is not required that the technology is ready until January 1, 2027. If your previous health plan is not ready when we make our first attempt, we will try again once their API is ready.
Sharp Health Plan offers a Patient Access API that allows you to access certain health information maintained by Sharp Health Plan through a third-party application of your choice. Through the Patient Access API, you can authorize an application to access certain health information, including claims, clinical information, encounter data, and other information made available through the API. You control which third-party applications have access to your data by giving permission.
The Patient Access API gives you another way to access and use your health information. You can choose a third-party application and authorize it to retrieve your information from Sharp Health Plan so you can view your health information in the application you select.
You control which third-party application you authorize to access your health information through the Patient Access API.
Before allowing an application to access your information, carefully review the application's privacy practices, terms and conditions, and information about how it will use and protect your health information.
Epic's authentication process allows a patient to review information provided by an app developer, including information about how the app is funded, whether it distributes data to other parties, and whether users can delete or see records of data collected by the app.
TO NOTE: HIPAA regulations protect and secure your health information when it is held by your health care provider or payers (SHP). HIPAA does not apply to your health information once you authorize a third party to access it.
To learn more about how Sharp Health Plan uses your health information, visit our Privacy Policy.
If you are provider, payer, or app developer, visit our Resources for Application Developers page.
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