Connecting Your Healthcare:
New Options for Managing Your Digital Medical Records
Starting in 2021, a new federal rule made it easier for Wellcare By Allwell Medicare members* to manage their digital medical records.
The Interoperability and Patient Access rule (CMS-9115-F) makes it easier for members to get their health records when they need it most. You now have full access to your health records on your mobile device. This allows you manage your health better and know what resources are available to you.
Starting in 2022, the Payer-to-Payer Data Exchange portion of the rule* will allow former and current members to request that their health records go with them as they switch health plans. For more information about this rule, visit the Payer-to-Payer Data Exchange section found on this web page.
IMAGINE:
- You go to a new healthcare provider because you don’t feel well and you can show that provider your health history from the past five years
- The provider uses that information to diagnose you and you quickly find the right specialist by checking an up-to-date provider directory
- You have a question about a claim, so you go to your computer or mobile device and, in minutes, you see if it’s paid, denied, or still being processed
- You can take your health history with you as you switch health plans
THE NEW RULE MAKES IT SO YOU CAN EASILY FIND INFORMATION** ON:
- claims (paid and denied)
- healthcare providers
- pharmacy directory data***
- specific parts of your clinical information
Patient Demographics
- first name
- last name
- previous name
- middle name
- suffix
- birth sex
- date of birth
- race
- ethnicity
- preferred language
Allergies & Intolerances
- substances (medications)
- substances (drug class)
- reaction
New Demographics
- current address
- previous address
- phone number
- phone number type
- email address
Clinical Notes
- consultation note
- discharge summary note
- history & physical
- imaging narrative
- laboratory report narrative
- pathology report narrative
- procedure note
- progress note
Vital Signs
- body height
- body weight
- BMI percentile (2-20 years)
- blood pressure
- heart rate
- respiratory rate
- body temperature
Health Concerns
Immunizations
Procedures
Medications
Laboratory Tests & Results
Assessment & Treatment Plan
Care Team Members
Having your information in one place can help you:
- Understand your health better
- Make better decisions
- Improve your health outcomes
- Reduce healthcare costs
- Carry information to new providers or health plans
At our plans, your privacy and the security of your PHI is a top concern. The new rule allows you to use an app from a third-party application developer (a company with no connection to company). You can use this app to look up your information.
We promise to give you information on:
- What to consider when selecting an app
- The ways your data can be used by the third party
- The importance of understanding the security and privacy practices of the app
- Federal agencies you can contact if you feel your rights to patient privacy have not been protected
The CARIN alliance is working to advance the exchange of health information. Learn more about third-party application privacy standards at www.carinalliance.com. The CARIN Code of Conduct is a set of best practices apps have adopted to protect and secure your health information. We will require third-party application developers to prove they will follow certain privacy standards by attesting to the CARIN Code of Conduct. Visit myhealthapplication.com/health-apps/connections/Carin for a list of apps that have attested to the CARIN Code of Conduct.
- Find a trusted app. Visit myhealthapplication.com/health-apps/connections/Carin for a list of apps that have attested to the CARIN Code of Conduct. This ensures they meet the strictest privacy and security guidelines.
- Download the app. Smartphone apps are available through the Google Play Store (Android) and the App Store (iOS). Web apps are available for computers.
- Create your account. Follow the instructions in the app of your choice to sign up and link your health information.
- Use your information to manage your healthcare. Now you have the information you need to make the best healthcare decisions for yourself.
FREQUENTLY ASKED QUESTIONS
For more information on CMS Policies and Technology for Interoperability and Burden Reduction visit https://www.cms.gov/Regulations-and-Guidance/Guidance/Interoperability/index.
Any health information from the plan with a date of service of January 1, 2016 or later will be made available.
You always have access to your health information. The health plan or provider you visit will not affect that.
Yes. You can use an app to see what shots you’ve had with a date of service January 1, 2016 or later.
No. The app you use will not be affiliated with the plan. You may also visit myhealthapplication.com/health-apps/connections/Carin for a list of apps that have attested to the CARIN Code of Conduct. Follow the instructions on the app to connect it with your health record.
There may be some apps that don’t follow all the privacy provisions. We will let you know which apps have agreed to follow our privacy guidelines. Have you already selected an app prior to us receiving a response from the app provider on their privacy policies? If so, you will have a chance to select another app within a certain timeframe. We recommend that you request a Notice of Privacy Practices from the app. If the app does not provide you with a Notice of Privacy Practices, we recommend that you choose another app. You may also visit myhealthapplication.com for a list of trusted apps.
You can access your information starting July 1, 2021. You will be able to access your plan information through the apps.
No. You do not have to use an app to access your healthcare info. You can contact your provider or health plan for needed information.
You give the app your permission when you enroll. The app will collect your health data such as:
- your claims
- medications
- diagnosis
- procedures
- doctor visits
Apps do have the ability to collect non-health data. Some apps let you have the option to provide that information. We recommend that you ask your app provider.
The health data of family members may be connected to your health account. If so, that data may be included with a request of your own data via the app.
You will need to contact your provider or health insurance company. The health app only makes data available from healthcare sources. The app does not create this data. Is the app showing incorrect information that was not sent to the app? If so, the app must correct this problem.
Ask the app provider for their notice of privacy and security practices.
Most apps will not be covered by HIPAA. Most apps will instead fall under:
- The Federal Trade Commission (FTC)
- The FTC Act.
The FTC Act protects against deceptive acts (e.g., if an app shares personal data without permission, despite having a privacy policy that says it will not do so).
The FTC provides information about mobile app privacy and security for consumers here: www.consumer.ftc.gov/articles/0018-understanding-mobile-apps
You can find more information about patient rights under HIPAA and who is obligated to follow HIPAA here: www.hhs.gov/hipaa/for-individuals/guidance-materials-for-consumers/index.html
You can also see the HIPAA FAQs for Individuals: www.hhs.gov/hipaa/for-individuals/faq/index.html
We recommend that you request a Notice of Privacy Practices from the app provider to understand your rights.
We recommend that you request a Notice of Privacy Practices from the app provider. This will help you understand how they respond to an incident. You have the right to file a complaint with enforcement agencies including the Office for Civil Rights (OCR) and the Federal Trade Commission (FTC).
Most apps will not be covered under HIPAA. Most apps will fall under:
- The Federal Trade Commission (FTC)
- The FTC Act
The FTC Act protects against deceptive acts (e.g., if an app shares personal data without permission, despite having a privacy policy that says it will not do so).
To learn more about filing a complaint with OCR under HIPAA, visit: www.hhs.gov/hipaa/filing-a-complaint/index.html
Individuals can file a complaint with OCR using the OCR complaint portal: ocrportal.hhs.gov/ocr/smartscreen/main.jsf
Individuals can file a complaint with the FTC using the FTC complaint assistant: reportfraud.ftc.gov
The app is meant for you to be able to see your data in one place. However, we recommend that you request a Notice of Privacy Practices. This will help you understand how the app will use your data.
We recommend that you request a Notice of Privacy Practices from the app provider. It will help you understand if the app will share your data with third parties.
We recommend that you request a Notice of Privacy Practices from the app provider. It will help you understand what happens to your data after you stop using the app.
We recommend that you request a Notice of Privacy Practices from the app provider. It will help you understand what happens to your data after you stop using the app.
The best way to stop sharing data is through the Third Party Application. You can also contact the Third Party Application support. Are you unable to successfully stop sharing data through the Third Party Application or by using the Third Party Application Support? You may call your plan's member services for assistance.
We recommend that you request a Notice of Privacy Practices from the app provider. This will help you understand if the app will share your data with third parties.
App providers may respond to user complaints in different ways. We recommend that you ask your app provider.
We recommend that you request a Notice of Privacy Practices from the app provider. It will help you understand how the app stores your data.
We recommend that you request a Notice of Privacy Practices. You can also request additional information on security practices. They will help you understand how they handle an incident.
We recommend that you request a Notice of Privacy Practices from the app provider. It will help you understand how you can limit the use and release of your data.
* Applies to Medicare Advantage, Medicaid and CHIP Managed Care and federally funded ACA exchange plans
** Data will be available for dates of service on or after Jan. 1, 2016.
*** For Medicare Advantage Prescription Drug (MAPD) plans
**** Vital Signs maintained by the Health Plan will be available.