Understanding How Your Health Information May Be Shared

At Sentara Health Plans, we want to help you get the care you need. The Centers for Medicare & Medicaid Services (CMS) has created secure ways to share health information electronically. This can help your doctors, health plan, and you get important information more quickly and easily. 

What Is an API?

An Application Programming Interface (API) is a secure way for computer systems to share information with each other. It helps health information move safely between health plans, providers, and approved applications. 

Types of APIs Available to Members

Patient Access API

The Patient Access API lets you see your health information through certain approved apps that you choose to use. You decide whether to connect your information to these apps.

Information may include:

  • Claims information
  • Health care visits and services
  • Clinical information
  • Prior authorization status and decisions (except prescription drug prior authorizations)

How It Helps You

The Patient Access API can help you:

  • View your health information in one place
  • Better understand your care
  • Stay informed about prior authorization decisions
  • Share information with caregivers if you choose

Provider Access API

The Provider Access API allows your participating health care providers to securely receive certain information from your health plan to support your treatment and care.

How It Helps You

This may help:

  • Reduce paperwork
  • Avoid repeating information
  • Improve communication between providers
  • Support better care coordination

Payer-to-Payer API

The Payer-to-Payer API allows health plans to securely share certain health information when you move from one health plan to another.

How it helps you:

  • Reduce delays when changing health plans
  • Improve continuity of care
  • Give your new health plan a better understanding of your health history

What Information May Be Shared?

Depending on the API, information may include:

  • Claims information
  • Clinical information
  • Health care encounter information
  • Prior authorization information and decisions (excluding prescription drug prior authorizations)

Who May Receive My Information?

In the Patient Access API

Only apps that you choose and authorize can receive your information.

In the Provider Access API

Participating providers involved in your care may receive information to help support treatment and care coordination. 

In the Payer-to-Payer API

Your information may be shared with another health plan if you choose to participate when changing coverage. 

How We Protect Your Information

Your privacy is important to us. We use security measures to help protect your personal health information. Access is limited to authorized people and organizations as allowed by law.

Your Choices

Provider Access API: Right to Opt Out

You can choose not to share your information through the Provider Access API. You can opt out by doing one of the options listed below:

  • Sign in to your Sentara Health Plan member account here: Member Portal - Sign In
  • Complete an online form
  • Call Member Services

If you opt out, your information will not be shared through the Provider Access API. 

Payer-to-Payer API: Right to Opt In

You must give permission before your information can be shared with another health plan through the Payer-to-Payer API. 

You can opt in by doing one of the options listed below:

  • Sign in to your Sentara Health Plan member account here: Member Portal - Sign In
  • Complete an online form
  • Call Member Services

Changing Your Choice

You can change your decision at any time.To update your choice:

We will process your request as quickly as possible.

Frequently Asked Questions

Yes. You can update your choice at any time.
No. You decide whether to connect your information to an approved app.
We use security measures designed to protect your personal health information.

Sharing information electronically can help improve care, reduce paperwork, and make it easier for providers and health plans to work together.

Example: Patient Access API
Sarah uses a health app on her phone. She chooses to connect the app to her health plan information. She can then see claims, health information, and prior authorization updates in one place.

Example: Provider Access API
Tom visits a specialist. The specialist may receive certain information from the health plan to help with Tom's care. If Tom has opted out of the Provider Access API, this information will not be shared through that API. 

Example: Payer-to-Payer API
Lisa changes to a new health plan. If she chooses to participate, her previous health plan may share certain information with her new health plan. This can help support her ongoing care. 

 

No. Your health plan benefits and coverage will stay the same.

Need Help?

Member Services: Please contact Member Services if you have questions about your privacy rights, your choices, or how your health information may be shared.

Member Services Medicaid: 1-800-881-2166 (TTY: 711)
Monday–Friday, 8 a.m.–8 p.m.

Sentara Community Complete (HMO D-SNP): 1-866-650-1274 (TTY: 711)
Sentara Community Complete Select (HMO D-SNP): 1-800-927-6048 (TTY: 711)
October 1–March 31 | 7 days a week | 8 a.m.–8 p.m. 
April 1–September 30 | Monday–Friday | 8 a.m.–8 p.m.

 

Sources:  cms.gov, itirra.com, health-samurai.io