21-551m Interoperability Connects You, Your Patients and Health Plans
Date: 07/30/21
This information applies to Physicians, Participating Physician Groups (PPGs), Hospitals, and Ancillary providers.
For Medi-Cal, this information applies to Kern, Los Angeles, Riverside, Sacramento, San Bernardino, San Diego, San Joaquin, Stanislaus, and Tulare counties.
Digital patient information in one place helps you make informed patient care decisions
In March 2020, the Centers for Medicare and Medicaid Services (CMS) finalized its Interoperability and Patient Access Rule (CMS-9115-F).1 Its goal is to enhance patients’ control over their healthcare information through digital technology.
Electronic exchange of health information
Interoperability focuses on operational efficiencies, higher quality medical care and improved health outcomes. By ensuring health plans and providers use common data formats and applications, the Interoperability Rule allows patient health information to be shared quickly and easily via third party applications. Patients can download the application with their health information to their phone.
Your call to action
The Interoperability Rules have three main areas of focus for providers. They are to ensure you properly support digital patient access to healthcare information. Providers must comply with:
- Information blocking prevention:
- Put policies and procedures in place to help prevent information-blocking practices. This includes any practice that interferes with the access, exchange, or use of electronic health information (EHI).
- Up-to-date digital provider information:
- Add your digital contact information online to your National Plan and Provider Enumeration System (NPPES) records. Work with your electronic health record (EHR) vendors to ensure your digital and National Provider Identifier (NPI) information are always current.
- Condition of participation (COP) compliance:
- Applies to all hospitals – Send electronic notifications to a patient’s healthcare provider (e.g., primary care practitioner) upon the patient’s admission, discharge or transfer (ADT).
How we support interoperability
- We offer a secure, standards-based application programming interface (API) that allows our members to easily access their own health care information – including claims, medical history, lab results and more – through a third-party app of their choice.
- Our members have secure and private access to their own EHR and educational resources.
- Our provider directory information is publically available via our API. This will help members and providers use third-party apps to connect with other providers for care coordination.
- We are building secure processes for data exchange with other health plans that align with the Office of the National Coordinator for Health Information Technology (ONC) rule’s technical standards.
Resources and guidance
You can learn more about interoperability by visiting these sites:
Resource | Description |
|---|---|
A bipartisan, multi-sector collaborative working to advance consumer-directed exchange of health information. | |
CARIN Code of Conduct | A set of industry-leading best practices that these applications have voluntarily adopted to protect and secure patient health information. For a list of applications that have attested to the CARIN Code of Conduct, visit the website. |
A Health Level Seven International (HL7®) standard for exchanging healthcare information electronically. It is the next generation exchange framework. | |
CMS | |
ONC |
Additional information
If you have questions regarding the information contained in this update, contact the applicable Health Net Provider Services Center within 60 days at:
Line of Business | Telephone Number | Provider Portal | Email Address |
|---|---|---|---|
EnhancedCare PPO (IFP) | 1-844-463-8188 | ||
EnhancedCare PPO (SBG) | 1-844-463-8188 | provider_services@healthnet.com | |
Health Net Employer Group HMO, POS, HSP, PPO, & EPO | 1-800-641-7761 | provider_services@healthnet.com | |
IFP (CommunityCare HMO, PPO, PureCare HSP, PureCare One EPO) | 1-888-926-2164 | provider_services@healthnet.com | |
Medicare (individual) | 1-800-929-9224 | provider_services@healthnet.com | |
Medicare (employer group) | 1-800-929-9224 | provider_services@healthnet.com | |
Medi-Cal | 1-800-675-6110 | N/A |
1 This was published alongside the Cures Act Final Rule from the HHS Office of the National Coordinator for Health Information Technology (ONC), which establishes further standards around interoperability practices.