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®,* start by contacting your other health plan.
Here are some things to keep in mind:
- A member can direct Aetna to receive their health data through the Payer-to-Payer Data Exchange if they’re currently enrolled in:
• A certain commercial plan, or
• A Medicare plan with Aetna Medicare Advantage, Allina Health | Aetna, or
• 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®
• A certain commercial plan, or
• A Medicare plan such as Aetna Medicare Advantage, Innovation Health or Allina Health | Aetna, or
• 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
Notes
*FOR AETNA REFERENCE: “Aetna” and the pronouns “we,” “us,” or “our’” may refer to one or more of the Aetna group of companies and their affiliates.
Transmitting health data to Aetna®
Current members of relevant Aetna health plans will use their member website to start the Payer-to-Payer data transmission. You'll 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, contact your other health plan to get it. You'll also need an active login ID and password for your Aetna member website. If you don't have a login ID and password, you can create one at your secure member website.
Follow the steps below to direct Aetna to receive your health data from another health plan.
- Log in to your member website.
- Select "Preferences" then "Privacy & Security."
- Select "Transmit Payer Data."
- Search for your former/other health plan using the exact name from that health plan's ID card: If your plan isn’t found, submit a connection request. We’ll contact you when the connection is made so you can continue the transmission.
- Provide your consent for Aetna to receive your health data from the former/other health plan.
- 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 former/other health plan.
- Aetna should receive your health data from the other health plan. You can check the status of the transmission on your secure member website.
Sending your health data to another payer
To send your health data maintained by Aetna®to another health plan, first contact your other health plan to learn how their Payer-to-Payer Data Exchange process works. For example, you may need to use a website or call your other health plan to get started.Have your Aetna ID card and member information with you.
When Aetna shares your health data with another health plan at your direction, we'll 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 any Aetna commercial health plans.
Review your Payer-to-Payer Data Exchange requests
On your member website, you can review:
- 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:
- Log in to your member website.
- Select "Preferences" and then select "Privacy & Security."
- Select/View the Current Data Access section.
Within the Current Data Access section, you'll 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 about the Payer-to-Payer Data Exchange
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.If you don’t want Aetna to send your health data to another health plan or receive your health data from another health plan, don’t start a Payer-to-Payer Data Exchange transmission.
Health plans under certain government programs such as Medicare, Medicaid, and Qualified Health Plans on the Federally Facilitated Exchanges, and certain commercial plans must, through the Payer-to-Payer Data Exchange:
- Receive health data for current members; and
- Send health data for current members and former members up to five years after disenrollment.
Only current members of Aetna-affiliated plans under certain commercial plans and certain government programs, such as Aetna Medicare Advantage 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 | Health, or Innovation Health receive their data from another payer.
Not sure if you’re eligible to use the Payer-to-Payer Data Exchange? Call us at the number on your member ID card to speak with our Member Services team.
Impacted Aetna plans will send certain clinical data they maintain in members’ records with a date of service on or after January 1, 2016. The Payer-to-Payer transmission currently shares the clinical data listed in the United States Core Data for Interoperability (USCDI) Version 1 (PDF).
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 an Aetna commercial health plan 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.
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 January 1, 2016. Aetna may send data from before January 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 shouldn't be used as a substitute for your full, official health records.
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 line with federal and state privacy laws, as well as our own company privacy policies. Refer to our 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.
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.
There is no charge for the data exchange or for Aetna to maintain your data received from another health plan.
Call the number on your Aetna ID card to reach our Member Services team.
Call the number on your Aetna ID card to reach our Member Services team.
You need to only log in with your current member login.
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’d like to direct Aetna to receive your health data from multiple other health plans, you need to make separate requests for each individual health plan.
Members aged 14 and older of a relevant plan can direct Aetna to share their health data using their secure member website.
For members aged 13 and under, a guardian or authorized representative can create an account for the member.
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.To help match you to your records with the other plan, we may ask that you provide the following information:
- Member ID card number
- Issuer/Payor
- Coverage ID
- Coverage identifier
- Group
- Subgroup
- Plan
- Subplan
- Class
- Coverage start date
- Coverage end date
Not all 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 starting the transmission process.
