Provider Access API: Frequently Asked Questions
What is the Provider Access API?
It is a secure electronic connection that allows your health plan to share your past medical history, insurance claims, and prior authorization records directly with your in-network doctors.
How does it benefit me?
It gives your care team a complete picture of your health. Your doctors can see your past treatments, medications, and approvals from other clinics instantly. This prevents repeated medical tests, cuts down on paperwork, and helps your doctors make safer, faster treatment decisions.
Do I need to download an app to use this?
No. The system works entirely in the background between your health plan and your doctor’s secure electronic health record software. You do not need to download, manage, or log into any third-party mobile apps.
What specific information is shared?
- Clinical data: Your past doctor visits, lab results, and medical history.
- Claims data: Detailed records of medical services billed to your insurance.
- Prior authorizations: The approval status of your upcoming treatments, procedures, or prescriptions.
Is any information excluded from this automated sharing?
Yes. Highly sensitive data is locked by default and will not be shared without your explicit separate consent. Excluded data elements include:
- Substance use disorder treatment records
- Private psychotherapy notes kept separate from your medical chart
- HIV/AIDS testing, diagnosis, or treatment records
- Genetic testing results
- Restricted reproductive health and family planning data
How quickly is my information updated in the system?
Under federal regulations, the data moves very fast. New medical claims, clinical records, and prior authorization updates must be available to your doctor within one business day of the health plan receiving them.
Am I required to participate in this data sharing?
No. While enrollment is automatic to make sure your doctors have your records during your next visit, participation is entirely voluntary. You have the right to opt out at any time.
How do I opt out of sharing my data?
You can stop your data from being shared in three ways:
- Online: Log into your MyChart account and update your privacy settings.
- By Phone: Call Member Services and state: "I want to opt out of the Provider Access API data sharing feature."
- By Mail or Fax: Request, sign, and return our standard paper Opt-Out form.
If I change my mind, how long does it take to process my request?
Once you submit an opt-out request, your health plan must stop sharing your data through the API within two business days. If you decide to opt back in later, your choice will also be updated within two business days.