Skip to main content
Wellmark Advantage Health Plan homepage

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)

  1. 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.
  2. Before using the app, you can contact the app directly to check if they have access to our APIs.
    1. If you can’t find any functionality on the app related to health plan interoperability, they may not have this feature enabled.
    2. If they do have interoperability enabled but don’t have it as a listed connection, the app may not be connected to us yet.
    3. You can contact the app to inquire if they have future plans to connect with Wellmark Advantage Health Plan.
  3. 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.
    1. We highly recommend you review the app’s privacy policy in detail to ensure you’re comfortable with how the app will handle your data.
  4. After you have provided consent and your member credentials, the app will be able to access your claims and other health information.
  5. 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.

It's important for you to understand that the app you select will have access to all your information. The app is not subject to HIPAA rules and other privacy laws. These rules and laws protect your health information. You'll be subject to the app’s privacy policy for how they will use, disclose, and sell information about you. If you decide to share your information through the Patient Access API, you should review their privacy policy to ensure you're comfortable with what the app will do with your information.

Find more information about things to consider PDF File when choosing to share your information with an app.

If the app's privacy policy doesn't answer these questions, you may want to reconsider. You should choose an app with strong privacy and security standards to protect your information.

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 Plan Phone: 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 call TTY: 711.

Other issues: For customer service, call the number on the back of your member ID card or TTY: 711

Last updated: 1/1/22 
}