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Registering as a Payer with Opala
Transferring Member Health Information
Introduction Payer-to-Payer Data Exchange If You Are a Payer The Payer-to-Payer Portal Transferring Member Health Data Requesting a New Payer
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Transferring Member Health Information

Users change payers throughout their lifetimes. To facilitate the creation of a comprehensive payer record, Opala provides an easy-to-use web interface, the Health Data Transfer page, for members who want to consolidate their previous payer information with their current payer.

Payer-to-Payer Data Exchange

The Rule indicates that payers regulated by CMS (Medicare Advantage, Managed Medicaid, CHIP, and Federal Exchange QHPs) must exchange the USCDI v1 data set , in electronic form, at the member's request. Payer-to-Payer Data Exchange provides a way to share this data between health plans. This enables members to have their clinical records follow them from health plan to health plan, creating a more consistent patient record. This process must be initiated by the member using Opala's white-labeled Health Data Transfer web page.

If You Are a Payer

For a payer's data to be available to members for transfer, either from or to, the payer must be registered with Opala. For more information on registration, see Registering as a Payer with Opala in this documentation set.

If a payer is not registered, a member can request registration for the payer from the Health Data Transfer page using the Request a New Payer link located below the Previous Insurer field. Once the payer is registered, the member can transfer their historical data from that payer to their current payer.

Note: A user can also initiate a transfer from Opala to their new payer using the new payer’s P2P data exchange.

The Payer-to-Payer Portal

Opala's Payer-to-Payer Portal can be accessed directly using https://p2p.opalahealth.io:45007/Health/Create

Transferring Member Health Data

The Payer-to-Payer Data Exchange feature enables a member to initiate the transfer of healthcare information from a previous payer to their account with their current payer. This feature uses a web page entitled Health Data Transfer. On this page, the member provides their Opala user credentials, specifies the previous payer whose information they want to retrieve, and signs into the previous payer using the login information provided by that payer when the user was a member.

A member can access the Health Data Transfer page from their My Health Portal page. To transfer your member information:

  1. Select the Go to Health Data Transfer button to open the transfer page.
  2. Select the previous payer you want to transfer health data from.
    • If the payer is not listed in the dropdown, select the Request New Payer link below this field to request that they be registered.
  3. Enter your name, email address, and the Member ID for your current payer.
  4. Enter the name of the person for whom data is being requested.
    • This can be the member who is making the request, or it can be someone whose healthcare data the member has the right to view, for example, a minor child.
  5. Select the I Agree checkbox to indicate that you accept the terms and conditions of the transfer.
  6. Select the Submit Request Button button.
  7. Enter your login information for the selected previous payer.

The data from your previous payer is transferred and incorporated into your records within three business days. You can then access your data using any registered third-party application.

Requesting a New Payer

If the payer you want to transfer your health information from is not registered, you can request that they be registered.

  1. Select the Request New Payer link.
  2. Enter the following information:
    • Name of Previous Insurer. Enter the name of the payer you want to be registered.
    • URL of Previous Insurer (Optional). If you know the URL of your previous insurer, enter it here; otherwise, leave this field blank.
    • First Name. Enter your first name, as it appears with the previous payer.
    • Last Name. Enter your last name, as it appears with the previous payer.
    • Email Address. Enter the email address you would like to be contacted at to be notified about the status of the payer request.
    • Primary Phone Contact. Enter the phone number you would like to be contacted at to be notified about the status of the payer request.
  3. Select the Submit Request Button button.
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