Payer-to-Payer Data Exchange (Opt-In Program)

Federal regulations require Medicare Advantage plans to give members the choice to authorize the exchange of certain health information between their previous health plan and their current health plan. By opting in, you allow your current health plan to request eligible information from a previous or concurrent health plan. 

No. Participation is completely voluntary.
You may choose whether to allow your health information to be exchanged through the Payer-to-Payer Data Exchange process. Choosing not to participate will not affect your enrollment, eligibility, benefits, premiums, or access to covered services.
 

Opting in may help:

• Support continuity of care when changing health plans.
• Reduce the need to repeat health history information.
• Help your health plan better understand your healthcare needs.
• Improve care coordination and care management activities.
• Reduce delays associated with obtaining historical health information. 

If you opt in, your current health plan may request certain health information maintained by your previous or concurrent health plan. Available information may include:

• Medical claims information
• Healthcare encounter information
• Prior authorization information
• Certain clinical information maintained by the health plan
• Coverage-related information required for healthcare operations 

Not necessarily.
The information exchanged is limited to the data maintained and available through participating health plans and applicable regulatory requirements. The specific information exchanged depends on what information is available from the previous or concurrent health plan.
 

Only authorized health plans participating in the data exchange process may receive applicable information when a valid request is made and you have provided authorization through the opt-in process. 
 

Health information exchanged through the Payer-to-Payer Data Exchange is transmitted using secure technology and remains subject to applicable federal and state privacy and security requirements.
Protecting the privacy and security of member information remains a priority throughout the exchange process. 
 

A previous payer is a health insurance company or health plan that provided your healthcare coverage before you enrolled in your current health plan.
Examples may include:

• Another Medicare Advantage plan
• Employer-sponsored coverage
• Commercial health insurance coverage
• Medicaid managed care coverage

Your current health plan may ask you to identify prior coverage as part of the enrollment or onboarding process. 
 

A concurrent payer is another health plan that provides health coverage at the same time as your current health plan.
If applicable, information may be exchanged with concurrent payers when permitted by applicable regulations and your authorization. 
 

You may be given the opportunity to opt in through a health plan enrollment process, member portal, written authorization form, Member Services interaction, or another approved method offered by your health plan. The specific methods available may vary by health plan. 
 

Yes.
You may change your decision regarding participation in the Payer-to-Payer Data Exchange by contacting Member Services. Changes will be processed according to the health plan's policies and applicable regulations.
 

If you opt in:
1.    Your health plan may request eligible information from your previous or concurrent health plan.
2.    The requested health plan may provide available information through the secure data exchange process.
3.    Your current health plan may use the information to support healthcare operations, care coordination, and continuity of care. 
 

No.

The Payer-to-Payer Data Exchange is a data-sharing process between health plans. It is separate from provider access processes and other healthcare information exchange programs.

No.
Your decision to participate or not participate will not affect your health plan benefits, covered services, eligibility, enrollment status, or premiums.
 

If you have questions about the Payer-to-Payer Data Exchange or your opt-in status, please contact Member Services.
Member Services Phone: 1-833-627-8252 (MAP-UCLA) 
TTY: 711
Hours of Operation: 

• April 1 through September 30: Monday - Friday, 8am - 8pm PST (except on federal holidays)
• October 1 through March 31: 7 days a week, 8am - 8pm PST (except on Thanksgiving Day and Christmas Day).
   

Participation in the Payer-to-Payer Data Exchange is voluntary. Your health information will only be exchanged in accordance with applicable federal and state laws, CMS requirements, and your authorization preference.