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 Aetna[2], 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 can direct Aetna to receive their health data through the Payer-to-Payer Data Exchange. 
  • Members enrolled in 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 | Aetna, 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.

Transmitting health data to Aetna

Current members of relevant Aetna health plans will use their member web 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 member web portal.  

Follow the steps below to direct Aetna Better Health to receive your health data from another health plan.

  1. Log into your member web portal
  2. Click into My Account
  3. In My Profile section select Data Access
  4. Select Transmit Payer Data
  5. Search for your former/other health plan using the exact name from that health plan's ID card:
    1. Select My Health Plan Isn’t Listed if your plan is not found. 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.
  6. Provide your consent for Aetna Better Health to receive your health data from the other/former health plan. 
  7. 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. 
  8. Aetna Better Health should receive your health data from the other health plan. You can view the status of the transmission on your member web 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 commercial health plans. 

View your Payer-to-Payer Data Exchange requests 

On your member web 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 member web portal
  2. Go to My Account
  3. Under My Profile select/view 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 

Who decides where I send my data?

  • 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. Do not start a Payer-to-Payer Data Exchange transmission if you do not want Aetna to send your health data to another health plan or receive your health data from another health plan.  

Who can send their health data from one payer to another? 

  • Health plans under certain government programs such as Medicare, Medicaid, and Qualified Health Plans on the Federally Facilitated Exchanges 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 government programs, 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 plan with Aetna CVS Health, Banner | Aetna or Innovation Health plan can request that Aetna receive their data from another payer.
  • If you are unsure if you are eligible to use the Payer-to-Payer Data Exchange, contact us at the number on your member ID card to speak with our member services team.  

What types of health data are shared by Aetna through the Payer-to-Payer Data Exchange? 

  • Impacted Aetna plans will send certain clinical data they maintain in members’ records with a date of service on or after 1/1/2016. The Payer-to-Payer transmission currently shares the clinical data listed in the United States Core Data for Interoperability (USCDI) Version 1. 
  • 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 one of Aetna’s commercial health plans 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.

How much of my data is shared?

  • 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 1/1/2016. Aetna may send data from before 1/1/2016 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 should not be used as a substitute for your full, official health records. 

How is my health data used by Aetna? 

  • 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 accordance with federal and state privacy laws, as well as our own company privacy policies. Please refer to your 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.

How will the other payers use my data?  

  • 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.

Does it cost me anything to share my data through the Payer-to-Payer Data Exchange?

  • There is no charge for the data exchange or for Aetna to maintain your data received from another health plan.  

I am having trouble with the process; what should I do?

  • Call the number on your Aetna ID card to reach our member services team. 

I need more information; who should I talk to?

  • Call the number on your Aetna ID card to reach our member services team. 

What if I have had more than one eligible health plan with Aetna? 

  • You need to only log in with your current member login.

How do I direct Aetna to receive my health data from all of my past health plans?  

  • 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 would like to direct Aetna to receive your health data from multiple other health plans, you must make separate requests for each individual health plan.

Can my child use this feature? 

  • Members age 14 and older of a relevant plan can direct Aetna to share their health data using their member web portal account.  
  • For members 13 and under, a guardian or authorized representative can create a web portal account for the member. 

What information may Aetna need to receive my health data from another health plan?

  • 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. We may ask that you provide some of the following information to help match you to your records with the other plan:
  • Member ID Card Number
  • Issuer/Payor
  • Coverage ID
  • Coverage Identifier
  • Group
  • Subgroup
  • Plan
  • Subplan
  • Class
  • Coverage Start
  • Coverage End
  • Not all of 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 beginning the transmission process.

 

[1] CMS-9115-F.

[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.