Payer-to-Payer Health Data Exchange

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. If you don’t want Aetna to send your health data to another health plan or receive your health data from another health plan, don’t start a Payer-to-Payer Data Exchange transmission.

Health plans under certain government programs such as Medicare, Medicaid, and Qualified Health Plans on the Federally Facilitated Exchanges, and certain commercial plans must, through the Payer-to-Payer Data Exchange:

1. Receive health data for current members; and
2. Send health data for current members and former members up to five years after disenrollment.

Only current members of Aetna-affiliated plans under certain commercial plans and certain government programs, such as Aetna Medicare Advantage 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.

Not sure if you’re eligible to use the Payer-to-Payer Data Exchange? Call 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 January 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:

• Vital signs
• Height
• Weight
• Smoking status
• Medications 
• Lab results 
• Conditions
• Procedures
• Immunizations

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 an Aetna commercial health plan 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 January 1, 2016. Aetna may send data from before January 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 shouldn't 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 line with federal and state privacy laws, as well as our own company privacy policies. Refer to our 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’d like to direct Aetna to receive your health data from multiple other health plans, you need to make separate requests for each individual health plan.

Members aged 14 and older of a relevant plan can direct Aetna to share their health data using their secure member website. 

For members aged 13 and under, a guardian or authorized representative can create an 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. To help match you to your records with the other plan, we may ask that you provide the following information:

• Member ID card number
• Issuer/Payor
• Coverage ID
• Coverage identifier
• Group
• Subgroup
• Plan
• Subplan
• Class
• Coverage start date
• Coverage end date

Not all 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 starting the transmission process.