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New regulations on data interoperability

Family looking at cellphone devices each in their own bubble

Interoperability is the ability of computers to connect and use information. In July 2021, the requirement to implement and maintain an Application Programming Interface (API), which is programming code that allows connection and data transmission between multiple software applications, went into effect for qualified health plans issued by the federally facilitated exchange.

Spotlight mandate: Patient access API

This regulation is designed to improve the ability of a member to electronically access their health care information and to increase the portability of that information. It will allow a member to retrieve data at the discretion of a member or personal representative. With this regulation, BCBSND must make claims data available for a third-party application that can provide members with information and options on services for their specific condition and location.

Who it applies to: Qualified Health Plans sold on the federally facilitated exchange and North Dakota Medicaid Expansion program members

Effective date: July 1, 2021, for Qualified Health Plans sold on the federally facilitated exchange; January 1, 2022, for Medicaid Expansion membership

Action required: Qualifying members must initiate a request for information by downloading a third-party application and choosing to connect their BCBSND data and registering. Individuals who are power of attorney, an authorized representative or a parent/legal guardian of a child under 12, will need to call the number on the back of the Member ID card to validate legal access to information. The individual’s identity will be verified, and an account will be set up for this individual upon verification of identity. For more information, please visit www.bcbsnd.com/interoperability.

Spotlight mandate: Payer-to-payer data exchange

The payer-to-payer data exchange requirement is intended to provide the means for members to keep all their health care data together. Health plans are required to maintain a method of electronic exchange of data (USCDI V1 data standard). The intent of this rule is to help members, providers and health plans coordinate care and reduce administration burden.  

Once the provisions of this rule are implemented by health plans, when a member moves from one health plan (health insurance company) to another, they can move certain information from their member records to their new health plan (to their new health insurance company).

Who it applies to: Past, current and future qualified health plan members and Medicaid Expansion members

Effective date: Effective date is pending further rulemaking

Action required: The member must initiate request to share data, which can be started by calling the customer contact center at the number on the back of your Member ID card.