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Payer-to-Payer Health Data Exchange

 
 

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.

 

 

What you should know about Payer-to-Payer Health Data Exchange

 

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: 

 

  • A Member currently enrolled in a Medicare plan with 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 Aetna, or Innovation Health can direct Aetna to receive their health data through the Payer-to-Payer Data Exchange. 
  • Members once enrolled in Medicare plans 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 plans with Aetna CVS Health, Banner Health, or Innovation Health in the last five years can direct Aetna to send their health data to another health plan. 
  • Aetna will send certain clinical data it maintains on the member, if any, going back to 1/1/2016. Aetna may send data from before 1/1/2016 in some instances. 
  • Aetna will also send data it has received from other health plans through the Payer-to-Payer Data Exchange.
  • Aetna will send or receive your health data through this Payer-to-Payer Data Exchange only with your or your personal representative's approval and direction. Do not start the process if you do not want to share your data.

 

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.

Transmitting health data to Aetna

 

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.

 

  1. Log into your secure member portal
  2. Select Preferences > Privacy & Security
  3. Select Transmit Payer Data
  4. Search for your former/other health plan using the exact name from that health plan's ID card: Submit a connection request if your plan is not found. We will contact you when the connection is made so you can continue the transmission.
  5. Provide your consent for Aetna to receive your health data from the other/former health plan. 
  6. The other health plan may require you to log in or enter your member information found on your ID card. If the information is not available on your other health plan's ID Card, contact your other/former health plan. 
  7. Aetna should receive your health data from the other health plan. You can view the status of the transmission on your secure member portal. 

Sending your health data to another payer

 

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. 

View your Payer-to-Payer Data Exchange requests

 

On your secure member portal, you can view:

 

  • The other health plans to which you directed Aetna to send your health data.
  • The other health plans from which you directed Aetna to receive your health data.
     

Follow these steps to view your requested health data transmissions: 
 

  1. Log into your secure member portal
  2. Select Preferences and then select Privacy & Security
  3. Select/View the Current Data Access section


Within the Current Data Access section, you will find:

 

  • Other health plans to which you directed Aetna to send your health data. 
  • Other health plans from which you directed Aetna to receive your health data.

General FAQs on the Payer-to-Payer Data Exchange 

 

1CMS-9115-F.

Legal notices

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.