Member Education FAQ

Jefferson Health Plans publicly reports prior authorization metrics in accordance with CMS Interoperability and Prior Authorization Final Rule (CMS-0057-F).

You have the right to:

  • Access your health information electronically 
  • Decide whether certain information is shared 
  • Change your choices at any time 

These rights are required by federal law and apply to all eligible members.

Yes. Federal rules require Jefferson Health Plans to explain, in plain language, how your data may be shared and what choices you have.

No. Your benefits, coverage, and eligibility do not change based on whether you allow or restrict data sharing.

Federal privacy laws allow health plans to share information with in-network providers for treatment purposes unless a member chooses to opt out.

Only in-network providers involved in your care may receive information through this system.

Yes. You have the right to opt out of provider data sharing at any time.

If you opt out:

  • Your data will no longer be shared through the Provider Access API
  • Providers may have less information when treating you 
  • Your benefits and coverage remain the same

Where available, Jefferson Health Plans may allow partial opt-out options. Customer service can explain your choices.

CMS requires consent choices to be enforced without delay. In some cases, updates may take up to 24 hours if this timing is clearly explained to members.

No. Once your opt-out is enforced, data should no longer be shared through that system. 

Yes. Members should receive confirmation that their request was processed.

Payer-to-payer data sharing allows health plans to securely share your health information when you move from one health plan to another.

Sharing information can help:

  • Avoid delays in care 
  • Reduce repeated paperwork 
  • Support continuity of treatment

No. Payer-to-payer data sharing requires your opt-in consent before any information is shared.

This may include:

  • Claims and encounter history 
  • Prior authorization approvals (excluding denied requests)

Yes. You may revoke your consent at any time.

You can manage your preferences through:

  • The member portal 
  • Customer service 
  • Other approved methods described by Jefferson Health Plans

Yes. Customer service staff are trained to explain your options and help you record your choices.

Yes. Requests may be submitted online, by phone, or through other approved methods.

Yes. All data sharing must follow HIPAA privacy and security requirements. 

Federal agencies, including CMS and the Office for Civil Rights, oversee compliance with privacy and consent requirements.

You may contact Jefferson Health Plans customer service for help or to report concerns.

CMS requires health plans to make education available across multiple channels to ensure accessibility for all members.

Yes. Language assistance and accessible formats are available upon request.

No. You are not required to take action unless you want to change how your information is shared.

You can return to this page, visit the member portal, or contact customer service at any time. 

The Patient Access API is a secure technology that lets you access your health and prior authorization information electronically through third-party apps you choose, such as health or wellness apps. It gives you more control and transparency over your health information.

When you authorize an app to connect via the Patient Access API, you can access:

  • Claims and explanation of benefits 
  • Encounter and clinical data 
  • Prior authorization requests and decisions (excluding drug prior authorizations) 
  • Plan coverage details
 

This access is provided securely and within one business day of the most recent update.

Yes. Before any app can access your health information via the Patient Access API, you must explicitly authorize the app. You control which app can access your data and can revoke access at any time.

Yes. At any time, you can disconnect an app and stop it from accessing your health data. You can do this through the app, your member portal, or by contacting our support team. Once access is revoked, the app will no longer receive new information.

No. Your health plan does not charge you to access your health information through the Patient Access API. Some third-party apps may have their own cost or subscription charges, so please review each app’s terms before use.

Yes. Your health information is shared using secure technology standards required by CMS. However, third-party apps you choose may have their own privacy practices that differ from JHP’s — you should review those before connecting.

No. Choosing to connect to the Patient Access API or not has no impact on your health benefits, coverage, or the care you receive.

You can continue to access your health information through the JHP member portal, customer service, or printed materials as before. The API is an additional option available for convenience and enhanced access.

Information available through apps using the Patient Access API is updated at least once every business day so that you and your authorized app have near real-time access to your latest health and prior authorization data.

No. Under CMS-0057-F, prior authorization data shared through the Patient Access API does not have to include drug prior authorization requests. It includes prior authorization information for non-drug medical items and services. 

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Thank you for the interest in our Interoperability program. To receive an access token to our APIs for your application, please complete the developer registration application. You must provide all requested information to allow for HPP to review and approve your application. Incomplete applications may be rejected or cause approval delays.

By registering for access to our Interoperability Developer Portal, you agree to our Terms of Use for API access.

Click Below for Additional Interoperability Resources