Frequently Asked Questions

Interoperability is the ability of two electronic systems to interact with one another by accessing, exchanging, or integrating data. An example of interoperability is the standard formatting of routing and account numbers on paper checks that allows any bank to read this data.

The Centers for Medicare and Medicaid Services (CMS) has provided rules for interoperability. These rules require health insurance companies to format and present data in a standard way so other eligible systems can easily access the data.

Premera encourages you to manage your own health data, including how you use it and who can access it. The interoperability standards defined by the government will make it easier and cheaper for other companies to develop applications or mobile apps that can look at your health data. These apps, if you choose to use them, may ask to access your Premera health data. They may be able to help you make decisions about your healthcare needs and spending. You’ll decide if you want to allow the apps to access your health data or if you want to use the app’s services.

You can also choose to have your clinical records follow you from one health plan to another—but only if you give permission.

A third-party app might allow you more control over your data or different insights into your data than you get from your secure Premera account. For example, an app may help you find the lowest-cost pharmacy in your area or review your latest healthcare expenses and remaining deductible. While most of this information is available in your secure Premera account, a third-party app may be able to provide other data, too.

Sharing your prior health plan data with your current health plan creates a more consistent patient experience between health plans. This sharing of health records helps Premera understand members’ health history better, leading to improved access to support and programs that benefit members. Health records will never be used to determine health coverage or rates.

The term "app" is short for "application," which is a program or software that allows people to interact with computers and mobile devices. Most commonly, an app refers to an application on a mobile device—for example, the icons on your home screen that allow you play games, access maps, shop, and more.

Third-party apps cannot access your Premera health data unless you give them explicit permission. You need to complete these steps to give an app access:

1. When you download an app, it will prompt you for permission to access your Premera health data. The prompt will open a sign-in page managed by Premera.
2. Enter the same username and password you use for your Premera account. If you do not have a Premera account, you will need to create one before proceeding.
3. You will then be prompted to provide consent for the app to access your data (or the data of those you represent, such as a child on your plan).
4. The app will now be able to access your health data from Premera.

Another health plan cannot access your Premera health data through the Payer to Payer Data Exchange unless you give them explicit permission. You need to complete these steps to give another health plan access:

1. Sign in at premera.com
2. After signing in to your online account:
   • Select My Health Data from the page footer
   • Select Payer-to-Payer Data Exchange
   • Select your previous payer (health plan)
3. Provide consent to the Payer-to-Payer Data Transfer and follow prompts for Previous Payer web credentials. (Please note: Your previous payer may require additional consent or a HIPAA authorization before releasing your data to Premera.)

Interoperability makes it easier for third-party apps or other health plans to access your health data, with your consent. Your health data exists without interoperability, like in your Premera account. However, interoperability allows apps or other health plans that wouldn't normally have your data to access and use your data.

Your Premera health data is yours, and only people or apps you authorize can access it. Premera is committed to helping you keep your data safe. Interoperability provides certain controls around access to your health data. Other people cannot authorize access to your health data unless they have legal authority (e.g., a personal representative).

Premera is committed to helping you protect your health data. However, interoperability rules state we must provide your health data to apps that you’ve allowed to access your data. This is why it’s important to carefully consider which apps you trust to access your health data. Review the app's privacy policy to determine if the app can sell your data and if you trust the app publishers. Only use apps that are trusted and well known.

Questions to ask before choosing an app:

• Will this app sell my data for any reason?
• Will this app share my data to third parties for purposes such as research or advertising?
• How will this app use my data? For what purposes?
• Will the app allow me to limit how it uses, shares, or sells my data?

For more questions to ask, visit the Things to Consider page.

Protecting your data is a priority at Premera. Premera protects your data through multifactor authentication and strong encryption when sending your data to third-party apps. There are government regulations that also help ensure your data is protected by healthcare and insurance companies. One of these regulations is known as the Health Insurance Portability and Accountability Act, or HIPAA.

Your personal health data is protected within Premera systems by HIPAA. All healthcare providers such as hospitals, doctors, clinics, and dentists are subject to HIPAA and are required to keep your information safe.

Find more information about your rights under HIPAA and who is obligated to comply with HIPAA.

For more information regarding Premera privacy and security policies, or to report a privacy incident, contact customer service here:

• Medicare Advantage members in Washington: 888-850-8526 (TTY: 711)
• Individual members in Alaska: 800-809-9361 (TTY: 711)

Each app creates a privacy policy and other policies that explain how they will use your health data and whether they can sell your health data to others. These policies control what they will do with your data, so it is important that you understand what you are agreeing to when you download a third-party app.

The app is also responsible for reporting accidental disclosure of your health data to you and appropriate government authorities. Interoperability rules give Premera little control over which apps can ask you for access to your data. This means you are responsible for deciding which apps you want to access your health data.

Once you give a third-party app access to your personal heath data, that data is no longer protected by HIPAA or Premera.

For most hospitals, doctors’ offices, and health insurance companies, HIPAA governs the privacy and security of health records stored online. But many web-based businesses that collect people’s health information are not covered by HIPAA. These include online services people use to keep track of their health information and online applications that interact with those services.

The Federal Trade Commission (FTC), the nation’s consumer protection agency, has issued the Health Breach Notification Rule to require certain businesses not covered by HIPAA to notify their customers and others if there is a breach of unsecured, individually identifiable electronic health information. FTC enforcement began on February 22, 2010.

Find more information regarding the FTC.

When you agree to share your data with a third-party app, Premera must send your claims, encounter, and clinical data, dating back to January 1, 2016. This may include your name, address, diagnoses, treatments you received, amounts paid to providers, and other claims data. Encounter data includes any data related to your interactions with healthcare providers that have been shared with Premera. Clinical data includes information Premera has collected for the purposes of case management, care coordination, or other services to you. The information Premera shares with the third-party app may include treatment information for substance use, mental health, HIV status, or other sensitive data.

When you agree to share your data with another health plan through the Payer to Payer Data Exchange, Premera must send your clinical data, dating back to January 1, 2016. This may include information Premera has collected for the purposes of case management, care coordination, or other services to you. The information Premera shares with another health plan may include treatment information for substance use, mental health, HIV status, or other sensitive data.

If you give a third-party app or another health plan access to your health data, Premera is required to provide any of your information that’s been collected, maintained, and stored while you were enrolled in a Premera plan, dating back to January 1, 2016.

Any information Premera has collected, maintained, and stored about you while you were enrolled in a Premera plan, dating back to January 1, 2016.

Take these two steps to stop sharing your data with a third-party app.

1. Stop the app from accessing any more data immediately. Sign in to your Premera member account, then click My Health Data in the footer. From the drop-down menu, select which app(s) you want to stop accessing your data. You can also contact customer service for help.
   • Medicare Advantage members in Washington: 888-850-8526 (TTY: 711)
   • Individual members in Alaska: 800-809-9361 (TTY: 711)
2. Contact the app and ask them to delete your data. Each app is voluntarily complying with their own privacy policy, including what they do when you no longer want them to have your data. Contact the company that publishes the app and follow its procedure for removal of your data from its records.

The transfer of your health information from Premera to another health plan will be a one-time transfer of your current health information dating back to January 1, 2016. Any additional data transfers will have to be requested and consented to separately. If the data has already been sent, please contact the other health plan to determine next steps.

We recommend the Premera Find Care directory for Medicare Advantage. You can also see basic information (name, address, phone, provider specialty) for Premera Medicare Advantage in-network providers via the provider API.

Both tools have the same provider list, but the Premera Find Care directory has more details and capabilities to help you decide where to get care. The provider directory API only has minimal information.

Looking to connect to Payer to Payer Data Exchange? Go to interoperability payer information.