Skip to main content

Payer-to-Payer Health Data Exchange

Starting January 1, 2022, members of health plans under certain government programs, like Medicaid, 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 Medicaid, to have the capability to send and receive certain clinical data between each other at the member's direction.

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 Medicaid plan with Aetna Better Health can direct Aetna to receive their health data through the Payer-to-Payer Data Exchange. 
  • Members enrolled in a Medicaid plan with Aetna Better 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.

 

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:

    • 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 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 should receive your health data from the other health plan. You can view the status of the transmission on your member web portal.  

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. 

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

  • 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.  
  • Health plans under certain government programs such as Medicaid 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 a Medicaid plan with Aetna Better Health 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.  
  • 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.
  • 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. 
  • 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.
  • 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 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. 
  • 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. 
  • 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
  • Note: 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.