Starting January 1, 2022, members of health plans under certain government programs, like Medicare Advantage, Medicaid, and Qualified Health Plans on the Federally Facilitated Exchanges, can direct their health plans to share their health data with other health plans (also known as payers or insurers). This Payer-to-Payer Data Exchange is an outcome of the Centers for Medicare and Medicaid Services (CMS) Interoperability and Patient Access Final Rule.1 The rule requires health plans under certain government programs, like Medicare Advantage, Medicaid, and Qualified Health Plans on the Federally Facilitated Exchanges, to have the capability to send and receive certain clinical data between each other at the member's direction.
This health data exchange is between two health plans. You can direct us to receive your health data from another health plan on our website. If you want another health plan to receive your health data held by Aetna2, you should start by contacting your other health plan.
Here are some points to know about the Payer-to-Payer Data Exchange:
2“Aetna” and the pronouns ‘we,’ ‘us,’ or ‘our’ may refer to one or more of the Aetna group of subsidiary companies and their affiliates.
Current members of relevant Aetna health plans will use their secure member portal to start the Payer-to-Payer data transmission. You will need your other health plan's name and member information found on that health plan's ID card. If you don't have this information, you should contact your other health plan to get it. You will also need an active login ID and password for your Aetna member site. If you do not have a login ID and password, you can create one at your secure member portal.
Follow the steps below to direct Aetna to receive your health data from another health plan.
To send your health data maintained by Aetna to another health plan, you must begin by contacting your other health plan to learn how their Payer-to-Payer Exchange process works. For example, you may use a website, or you may need to call the other health plan. We suggest that you have your Aetna ID card and member information with you.
When Aetna shares your health data with another health plan at your direction, we will send all required clinical data we maintain as a part of your record. This will include health data Aetna has received from other health plans through the Payer-to-Payer Data Exchange, if applicable. We will not send your Aetna claims data or encounter data. We may not send data we have about you as a member of one of Aetna's commercial health plans.
On your secure member portal, you can view:
Follow these steps to view your requested health data transmissions:
Within the Current Data Access section, you will find:
You decide whether Aetna will receive your health data from another plan. You also control whether your health data held by Aetna can go to another plan. Do not start a Payer-to-Payer Data Exchange transmission if you do not want Aetna to send your health data to another health plan or receive your health data from another health plan.
Health plans under certain government programs such as Medicare, Medicaid, and Qualified Health Plans on the Federally Facilitated Exchanges must, through the Payer-to-Payer Data Exchange:
Only current members of Aetna-affiliated plans under certain government programs, such as Aetna Medicare Advantage, Innovation Health or Allina Health | Aetna, a Medicaid plan with Aetna Better Health or Mercy Care (Az.), or an individual exchange plan with Aetna CVS Health, Banner | Health, or Innovation Health receive their data from another payer.
If you are unsure if you are eligible to use the Payer-to-Payer Data Exchange, contact us at the number on your member ID card to speak with our member services team.
Impacted Aetna plans will send certain clinical data they maintain in members’ records with a date of service on or after 1/1/2016. The Payer-to-Payer transmission currently shares the clinical data listed in the United States Core Data for Interoperability (USCDI) Version 1 (PDF).
The kinds of clinical data that may be shared include:
Health data shared could be related to sensitive conditions such as chronic diseases, communicable diseases, substance use disorders (alcohol/drug), HIV/AIDS, sexually transmitted diseases, genetic marker information, and other personal health information (PHI) about behavioral health.
We may not send health data we have about you as a member of one of Aetna’s commercial health plans as part of this Payer-to-Payer transmission. We will not send your Aetna claims or encounter data as part of this Payer-to-Payer transmission.
If you direct Aetna to send your health data to another health plan, Aetna will send required clinical data with a date of service on or after 1/1/2016. Aetna may send data from before 1/1/2016 in some instances. Aetna will also send health data it has received about you from another health plan through the Payer-to-Payer Data Exchange previously.
The health data Aetna sends through the Payer-to-Payer Data Exchange may not reflect your complete medical history and should not be used as a substitute for your full, official health records.
Aetna will receive or send your health data through the Payer-to-Payer Data Exchange only at your direction. Aetna considers personal health information confidential. We protect the privacy of that information in accordance with federal and state privacy laws, as well as our own company privacy policies. Please refer to your Notice of Privacy Practices for more information on how we may use and disclose information about you in administering your benefits and your legal rights regarding such information.
Once you tell us to share your health data with another health plan, Aetna does not know or control how that other health plan may use or share your health data. To understand how another health plan may use or share health data, contact that health plan.
There is no charge for the data exchange or for Aetna to maintain your data received from another health plan.
Call the number on your Aetna ID card to reach our member services team.
Call the number on your Aetna ID card to reach our member services team.
You need to only log in with your current member login.
You may direct Aetna to receive your health data from any health plan that has provided coverage to you in the last 5 years.
If you would like to direct Aetna to receive your health data from multiple other health plans, you must make separate requests for each individual health plan.
Members age 14 and older of a relevant plan can direct Aetna to share their health data using their secure member portal account.
For members 13 and under, a guardian or authorized representative can create a portal account for the member.
How other health plans verify your identity and/or gather your consent before sending your health data to Aetna will vary. It is helpful to have your ID card from your other health plan. We may ask that you provide some of the following information to help match you to your records with the other plan:
Not all of the information may be needed to match your data to your identity. We recommend contacting your other health plan and having as much of this information ready as possible before beginning the transmission process.
Health plans are offered or underwritten or administered by Coventry Health Plan of Florida, Inc., Aetna Health Inc. (Georgia), Aetna Life Insurance Company, Aetna Health of Utah Inc., Aetna Health Inc. (Pennsylvania), or Aetna Health Inc. (Texas) (Aetna). Aetna is part of the CVS Health family of companies.
Aetna®, CVS Pharmacy, Inc. and MinuteClinic, LLC (which either operates or provides certain management support services to MinuteClinic®-branded walk-in clinics) are part of the CVS Health® family of companies. Aetna is the brand name for products and services provided by Aetna Life Insurance Company and its affiliates.
Health benefits and health insurance plans contain exclusions and limitations.