Access Management
Third-party Vendor Portal
Added new Optum Branding
Patient Access APIs
Claims APIs
CARIN Consumer Directed Payer Data Exchange (CARIN IG for Blue Button®):
http://hl7.org/fhir/us/carin-bb/history.html
1. Updated “id” data type from “string” to “token” for the following resources:
Conformance | Resource | Parameter | Type | Example |
|---|---|---|---|---|
| Conformance SHALL | Resource ExplanationOfBenefit | Parameter | Type token | Example GET [base]/ExplanationOfBenefit?_id=[id] |
| Conformance SHALL | Resource Coverage | Parameter _id | Type token | Example GET [base]/Coverage?_id=[id] |
| Conformance SHALL | Resource Patient | Parameter | Type token | Example GET [base]/Patient?_id=[id] |
2. Added the ability to perform search operation by multiple comma-separated “_id”s. Example: GET [base]/Coverage?_id=[id1],[id2],[id3]
Public Directory APIs
Provider Directory APIs
DaVinci PDEX Plan Net: http://hl7.org/fhir/us/davinci-pdex-plan-net/history.html
1. Added the ability to perform search operation by “_revinclude” for the following supported attributes, which allows the search response to include resources that have a relationship to the primary resource(s) in the search request:
Resource | Supported _revinclude attributes |
|---|---|
| Resource Organization | Supported _revinclude attributes HealthcareService:organization |
| Resource OrganizationAffiliation:primary-organization | |
| Resource PractitionerRole:organization | |
| Resource PractitionerRole:network | |
| Resource OrganizationAffiliation:participating-organization | |
| Resource Practitioner | Supported _revinclude attributes PractitionerRole:practitioner |
2. Added the ability to perform search operation by multiple comma-separated “_id”s. Example: GET [base]/Practitioner?_id=[id1],[id2],[id3]
Payer to Payer (future functionality)
In 2021, the Centers for Medicare and Medicaid Services (CMS) opened the door for health plan members to easily access and share their health data. Members can securely and seamlessly transfer their health information from a prior health plan to their new health plan (Payer). Members must grant Payers permission to access their previous health plan information.
Functionality to support this member-initiated Payer to Payer data exchange has been implemented for Data Acquisition and Data Externalization workflows. However, full functionality in production is dependent on forthcoming CMS updated rulemaking and other Payers supporting Payer to Payer registrations.
Data Acquisition:
A current member of Optum Tooele requests their health data be obtained from their previous or another current Payer (e.g., Aetna, Medicare)
Data Externalization:
A member with a different Payer (e.g., Aetna, Medicare) requests Optum Tooele send their health data to their new Payer. The member must be a current or past member of Optum Tooele to initiate this request. Data Externalization is only allowed within 5 years of leaving the covered health plan