Patient Access API
Everything you need to know about what interoperability means for you.
What is this about?
If you purchased your own insurance on the Marketplace or you have a Medicare plan, you're entitled to access and share your health information. Wellmark Advantage Health Plan now makes this process easier.
Your health information is available for other apps to use through a Patient Access Application Program Interface, or API. This interoperability technology allows applications to talk to each other by exchanging data.
What this means for you
As a member, you now have the ability to share your health information with third-party apps.
You can share your information dating back to Jan. 1, 2020, if you're enrolled in certain health plans. The following information is available as long as we maintain it in our records:
- Claims and other health information (one day after processing)
- Clinical data that we collect for care purposes, such as lab results (one day after we receive the data)
How do I use the APIs? (step by step)
- You can use any device (e.g., mobile phone, tablet, PC) to search for and download a third-party application that may have access to our Patient Access API.
- Before using the app, you can contact the app directly to check if they have access to our APIs.
- If you can’t find any functionality on the app related to health plan interoperability, they may not have this feature enabled.
- If they do have interoperability enabled but don’t have it as a listed connection, the app may not be connected to us yet.
- You can contact the app to inquire if they have future plans to connect with Wellmark Advantage Health Plan.
- The app will ask you to provide consent to access your data from Wellmark Advantage Health Plan. You may be prompted with a series of disclaimers and notifications.
- After you have provided consent and your member credentials, the app will be able to access your claims and other health information.
- See below for more information around our Frequently Asked Questions and how to submit concerns or complaints.
Additional information can be found in our Frequently Asked Questions for Medicare & Medicaid Services Interoperability and Patient Access Final Rule PDF File. The data made available, through the API, may include information about treatment for behavioral health, chronic illness and other sensitive information.
Find more information about things to consider PDF File when choosing to share your information with an app.
Covered entities and HIPAA enforcement
The U.S. Department of Health and Human Services’ Office for Civil Rights, or OCR, enforces the HIPAA Privacy, Security, and Breach Notification Rules. Your Blue Cross health plan is subject to HIPAA as are most health care providers, such as hospitals, doctors, clinics, and dentists. You can find more information about your rights here: HHS HIPAA Rights Website External Link under HIPAA and who is obligated to comply with HIPAA.
You can learn more HHS Complaint Materials External Link about filing a complaint with OCR related to HIPAA requirements. You may also file a complaint with Blue Cross by contacting the appropriate Customer Service office or by dialing the number listed on the back of your member ID card.
Wellmark Advantage Health PlanPhone: TTY: 711
Apps and privacy enforcement
An app generally will not be subject to HIPAA. An app that publishes a privacy notice is required to comply with the terms of its notice, but generally is not subject to other privacy laws. The Federal Trade Commission Act protects against deceptive acts, such as an app that discloses personal data in violation of its privacy notice. An app that violates the terms of its privacy notice is subject to the jurisdiction of the Federal Trade Commission, or FTC. The FTC provides information about mobile app privacy and security for consumers: Federal Trade Commission- Consumer Information on Understanding Mobile Apps External Link.
If you believe an app inappropriately used, disclosed, or sold your information, you should contact the FTC. You may file a complaint with the FTC here: FTC Complaint Assistant External Link.
Registering third-party developer app
In order to enable API connections, third-party developers must register their app PDF File with Innovaccer to make the app available for use by members.
Reporting privacy or PHI (protected health information) concerns
Privacy Questions: To report a concern or if you think your protected health information has been compromised please callTTY: 711.
Other issues: For customer service, call the number on the back of your member ID card orTTY: 711