Interoperability for Providers

The Provider Access API is a secure digital system that lets your in-network healthcare providers access important information your health plan already has about you — but only if they are currently treating you. This helps your doctor get a more complete picture of your health.

• Better, safer care
  Your providers can see details that help them make more informed decisions, such as medications, conditions, or recent test results.

• Fewer forms & repeated questions
  Your care team doesn’t have to ask you for the same information over and over — they can retrieve what they need directly.

• Faster coordination between your plan and your providers
  This supports quicker, clearer communication between your health plan and your care team.

Your health plan may share the following with your in network providers:

• Claims & encounter information (doctor visits, procedures, tests — but not billing details like cost sharing)
• Clinical information such as allergies, medications, conditions, test results, demographic info
• Prior authorization details except drug prior authorizations

Providers may access information for a single patient or in bulk (for example, for all their patients who are members of your health plan).

• You may opt out
  You can choose not to allow your health plan to share your information with your providers.
• Only providers treating you can access your data
  Your plan must verify that a provider has an active relationship with you before sharing anything.

Yes. The API uses secure, standardized FHIR technology to make sure your data is protected during electronic exchange.

As a patient, nothing unless you want to opt out.

If you’re comfortable with your care team having access to accurate information, you don’t need to take action. If you prefer not to share, your plan will tell you how to opt out.

When you switch health insurance plans, important parts of your health history don’t always move with you. The Payer to Payer API is a new, secure digital tool that allows your old and new health plans to share your information electronically—only if you say yes.

• Better continuity of care
  Your new plan gets a more complete health picture, helping you get the right care faster.
• Less repetition
  No more retelling your full medical history or tracking down old records.
• Fewer delays
  Your new plan can make faster decisions, especially for services requiring prior authorization.

If you give permission, your plans may securely exchange up to five years of:

• Claims and doctor visit history
• Clinical information your plan stores (such as conditions, lab results, medications)
• Prior authorization decisions and reasons
• Information held by care management organizations working with your plan

Your information will only be shared if you opt in.

You can choose whether to allow the exchange, and you can change your mind later.

Yes. The rule requires health plans to use secure, standardized technology (FHIR) to protect your data during transfer.

If you switch plans:

1. Your new insurance may ask if you want to share your information.
2. If you say yes, they will request it securely from your previous plan.
3. You don’t need to collect anything yourself.

The Payer to Payer API ensures your new health plan has the information needed to support your care—without extra work for you and with your full control.