Sharing Data Between Health Plans
Payer-to-Payer Data Exchange
You can choose to let your health plans securely share your health information when you change health plans or have more than one plan. This is called Payer-to-Payer Data Sharing.
Your information is only shared with your consent to help keep your care and health records up to date.
What Information Can Be Shared
If you consent, your current or new health plan can receive important information from another health plan, such as:
- Past medical claims and visits (up to 5 years)
- Key clinical information needed for care coordination
- Prior authorization history for non-drug services
This information is shared securely and electronically between health plans.
What this means for you
Fewer gaps in care when you switch plans
Your new health plan can better understand your health history without delays.
- Ongoing treatments are less likely to be interrupted
- Your care does not have to start over when your insurance changes
Less paperwork and fewer phone calls
Health plans can exchange information for you, so you do not need to track down records, repeat your health history, or refill forms
Faster, more accurate coverage decisions
Plans can better understand ongoing needs, chronic conditions, and recent care.
Better coordination between plans
If you have more than one plan:
- Faster coverage decisions with fewer questions early in the process.
- Better coordination of benefits.
Protecting Your Privacy
Your privacy is always protected:
- Sharing only happens if you opt in
- Only health plans you approve can exchange information
- Data is used only for healthcare and coverage purposes
- You can decline or opt out at any time through the Payer-to-Payer Data Exchange Consent Management System.
Choosing not to share your information will not affect your eligibility or benefits.
Manage Your Data Sharing Preferences
To review or update your data-sharing preferences visit Payer-to-Payer Data Exchange Consent Management System or contact Member Services using the phone number on your Member ID card.
Frequently Asked Questions
With your consent, Payer-to-Payer Data Sharing allows health plans to securely share your health information when you change health plans or have more than one plan.
Sharing helps your health plans:
- Understand your health history sooner
- Reduce delays in care or coverage
- Avoid asking you to repeat information or resubmit paperwork
- Helps your care and coverage continue uninterrupted
With your consent, this sharing can occur:
- When you switch to a new health plan
- When you have more than one health plan at the same time
- When your new plan needs information to support your ongoing care
If you consent, your health plans may share:
- Past medical claims and visits (up to 5 years)
- Important clinical information used for care coordination
- Prior authorization history for certain services
Note: Prescription drug prior authorizations and financial payment details are not included.
Only approved health plans involved in your coverage can exchange this information. It is not shared with employers, marketers, or other third parties.
Yes. All data sharing must follow federal privacy and security laws and uses secure, standardized technology to protect your information.
No. Sharing your information is your choice
Note: Choosing not to share your information will not affect your eligibility or benefits
Yes. You can stop sharing your information at any time through the Payer-to-Payer Data Exchange Consent Management System or by calling Member Services.
If you choose to stop sharing your information, it will only affect future sharing. Any previously shared information will remain with health plans that have already received it.
No. Your decision to share or not share your information will not affect your eligibility, benefits, or coverage.
Possibly. While Payer-to-Payer Data Sharing reduces paperwork, there may still be times when your provider or health plan needs additional details from you.
Payer-to-payer sharing lets health plans share information when your coverage changes or when you have more than one plan.
Payer-to-provider sharing lets your doctors access your health information to support your care. You can find more information about provider data sharing on your member portal under Data Sharing and Consent. Both are protected by privacy safeguards and help reduce how often you need to share the same information.