The CMS Interoperability and Patient Access rule aims to provide members with better access to their health information and improve data exchange between health plans. The Payer-to-Payer data exchange requirement ensures that when members move from one health plan to another, their clinical data from up to five years can seamlessly transfer between the former and new health plan, if maintained by the health plan. This enables continuity of care and ensures that healthcare providers have up-to-date information to make informed decisions about your care. L.A. Care Health Plan has implemented the Cloud Payer To Payer service to facilitate this data exchange process, making it easier for members to share their clinical data from their former health plan or new health plan.
To share clinical data with L.A. Care from your former health plan, members should follow these steps:
1. Select the link
Select the following link to access the Cloud Payer To Payer service:
2. Sign in
- On the Cloud Payer-To-Payer service start page, sign in with your Patient Access API username and password.
- If you are not registered for the Patient Access API, you can create an account during the login process.
3. Provide consent
Provide consent to the service to access your data.
4. Initiate Data Request:
- Find your former payer’s organization profile on the Initiate Data Request page.
- If your former payer is not listed, click "Request Edifecs to Add the Healthplan" and provide their contact information. Edifecs Support will add them and notify you.
5. Submit a request
- Once the former payer is added, click "Raise New Request" on their profile tile.
- You will be redirected to your former payer’s Payer-to-Payer solution. Log in with the credentials provided by your former payer and provide consent to access your data.
6. Track the request
After submitting, you can track the status on the My Data Requests page.
7. View Completed Request:
Once the data transfer is complete, view the received information on the completed request.
Request Data from L.A. Care to Your New Health Plan
If you are moving to a new health plan and would like to share your data with the new plan, inform the new plan to send a request to L.A. Care. Your new plan will be added as a Third-Party application developer, and we will provide the necessary endpoints to connect to our Patient Access API solution and access member clinical data.