Interoperability and Your Health Information
Interoperability is available to all members of CommunityCare health plans. That means members have the potential to use third-party applications to view benefit information.
What is Interoperability?
Interoperability allows various information systems, devices, and applications to access, exchange, integrate, and cooperatively use data in a coordinated manner. This exchange of data provides seamless portability of information optimizing the health of individuals and populations globally. Interoperability empowers members to have greater ownership of and visibility into their health data and has the potential to improve both their health and quality of care received from the health care system.
What it means for you: Access to your health information
It is important for our members to take an active role in protecting their health information. Helping you know what to look for when choosing an app can help guide you to make more informed decisions. Look for easy-to-read documentation and a privacy policy that clearly explains how the app will use your data. Using an app that does not have a privacy policy is not advised.
Your Privacy and Data Sharing
If a member chooses to share their CommunityCare data with a Third-Party Health App, the app will be may be able to access and store information such as:
- Member’s Demographics or Basic Details (Name, Date of Birth, Address, Phone Number, Email)
- Insurance Plan Information (Member’s Coverage Type, Plan Name, Member ID)
- Explanation of Benefits (EOB) (Claim Type, Claim Provider, Diagnosis, Services or Procedures Performed, Dollar Amount Billed and/or Paid)
- Your medical history and past procedures
- Clinician notes or descriptions of your medical conditions
- Your medication history, including vaccinations or immunizations
- A list of providers and organizations involved in your care
Some of this information could include or reveal sensitive topics such as mental-health status, pregnancy information, reproductive health, substance use, HIV status, genetic testing, domestic or physical abuse, or other sensitive diagnoses.
Supported Interoperability Integrations
- Patient Access
- Members will be required to register with and authenticate through 1upHealth Member Portalcoming soon during the third-party app activation process.
- Recommended third-party apps include:
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b.well
myFHR by CareEvolution
Flexpa
mPowered
OneRecord
Wisely Health
Primary Record
Sheer Health
- Provider Access
- Members are opted-in by default
- How to Opt Out:
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- Benefits of Provider Access:
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- Providers have a more complete health records and access to information leading to improved care and health outcomes.
- Less burden on the member to remember all details of their medical history.
- Potential for cost savings by decreasing duplication of services and lowering administrative costs.
- Payer-to-Payer Data Exchange
- This is a new form of interoperability that has been introduced by the Center for Medicare and Medicaid Services (CMS). This allows the health data of members to follow them safely when health plans are switched, or if a member has more than one health plan active at the same time.
- Members are in Control!
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- Members are opted out of the Payer-to-Payer data exchange by default. This means that no data is shared without the consent of the member.
- Once opted in, the payer has the ability to request the last five years of health data from the previous plan(s), if available.
- Benefits of Opting In:
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- Improved completeness of medical records, especially if there has been a change in carriers.
- Reduction of care disruptions.
- Faster approvals for treatment and improved coordination.
- How to Opt In:
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What types of organizations may or may not be covered under HIPAA?
The Health Insurance Portability and Accountability Act (HIPAA) requires that Covered Entities protect the privacy and security of your health information. Covered Entities include health care providers, health insurance plans, and healthcare clearinghouses. Physicians, hospitals, and other entities that provide your care are usually HIPAA covered entities. CommunityCare is a covered entity. The Health and Human Services Office of Civil Rights (OCR) oversees Covered Entities’ compliance with HIPAA to ensure they are following requirements to protect your health information.
Most apps are not covered by HIPAA. Instead, the Federal Trade Commission (FTC) oversees their compliance with the FTC Act, which protects against deceptive practices, such as an app sharing personal data without permission. We suggest you review the Notice of Privacy Practices for the app provider for information on how your data will be shared.
Filing a Complaint
If you suspect inappropriate use of your data by a third party application, you may file a complaint directly with the Federal Trade Commission (FTC)
by using the FTC complaint assistant found at https://reportfraud.ftc.gov/ or by contacting the FTC Consumer Response Center at 877-382-4357.
In addition, you may file a complaint about a potential data breach or violation of your privacy rights directly to the
Secretary of Health and Human Services, 200 Independence Avenue SW, Washington, D.C. 20201, phone (877) 696-6775(toll free), or
through the Office of Civil Rights complaint portal at https://ocrportal.hhs.gov/ocr/smartscreen/main.jsf.
If you believe that your privacy rights have been violated or that your data has been used inappropriately, you may report the matter to
CommunityCare by calling CommunityCare's Customer Service Department or by writing directly to our Compliance Officer.
Complaints to CommunityCare’s internal privacy office may be directed to our Grievance and Appeals Coordinator or Compliance Officer:
CommunityCare
Customer Service, Tulsa: (918) 594-5200
Customer Service, Statewide toll-free: 1-800-278-7563
Customer Service, TTY/TDD: toll-free: 1-800-722-0353
CommunityCare
Attn.: Compliance Officer
Two West Second Street, Suite 100
Tulsa, OK 74103
CommunityCare
Attn.: Grievance and Appeals Coordinator
P.O. Box 3249
Tulsa, OK 74101
Prior Authorization Metrics
Provider Directory API
Commercial Plans
Medicare Advantage Plans
Individual & Family Plans purchased through Healthcare.gov
How to register your third-party application - for App Developers
The developer portal, linked below, provides documentation on how to use and access our interoperability APIs.
Our APIs are based on the Health Level 7® (HL7) Fast Healthcare Interoperability Resources (FHIR®) standard.