Interoperability and Patient Access Rule 

Because we have smartphones and other devices, we can look up almost anything online. And now, you’ll be able to find your own medical record online, too. 

This is happening because of a new rule from the Centers for Medicare & Medicaid Service (CMS). It is called the Interoperability and Patient Access Rule. It requires Medicaid plans like Highmark Health Options Duals to give members online access to their medical record, including claims information.

What does this mean for you? 

This rule puts you first. It means you can see your medical record online, using any device you choose, any time you choose. You can:

• Control your information.
• Get to your information quickly, when you need it most.
• Use the information to make informed decisions about what care you receive, and where.

CMS describes it this way: “Consumers routinely perform many daily tasks on their mobiles phones—banking, shopping, paying bills, scheduling—using secure applications. We believe that obtaining their health care information should be just as easy, convenient, and user-friendly.”

The goal is to give patients more choice. And to promote competition in health care.

Who is the rule for?

This rule is for people who use Medicaid managed care programs like Highmark Health Options Duals. It is also for users of other Medicaid, Medicare Advantage, CHIP, and ACA programs. (ACA coverage is obtained through the Affordable Care Act marketplace.)

How will the rule work?

Because of the CMS rule, new applications (apps) are being built for many purposes related to health care. The application programming interface, or API, is called Blue Button 2.0 API. Think of it like an app store for health care systems. Through it, you can find and use apps that follow CMS security and privacy guidelines.

What do you need to do?

Highmark Health Options Duals will publish additional information as it becomes available.

• Begin by thinking about how health care apps can be most helpful to you.
• Select the primary app you want to use to see your medical record.
• Stay informed about ways to maintain your privacy on the apps you use.