Individual Market News
Published May 11, 2021
The Office of the National Coordinator for Health Information Technology (ONC) and the Center for Medicare and Medicaid Services (CMS) has introduced a rule to help drive interoperability and the exchange of patient data across healthcare systems. The goal is to give members timely access to their health data so they can better manage their own care.
We're now required to provide members access to their clinical records in an electronic format within 24 hours of a request. And starting July 2021, CMS will be enforcing the new rule.
Here's who's impacted and how this implementation will work:
- This will impact our Medicare Advantage (MA) and all individual Alaska lines of business, including off-exchange and grandfathered/grandmothered plans. It will possibly impact other lines of business in the future.
- We're creating a patient access application programming interface (API). This is a software connection that allows third-party apps to access member health data.
- Our patient access API will be available to current Premera Medicare Advantage members and Premera Alaska Individual plan members.
- The patient access API will give members access to their claims, pharmacy, encounter, and clinical data dating back to 2016.
- Members will also have access to a provider directory API, and a MA provider directory will be available to the public.
- To access their data, members will need to download a third-party application from their app store, and grant it access to their data.
- Premera is advising members to choose their third-party apps wisely. Premera can't guarantee member health data will remain secure and private when using a third-party app because they aren't required to comply with HIPAA or other state and federal laws.
You can learn more about interoperability on the CMS website. We'll also have a My Health Data web page for members available prior to July 1.