Humana Interoperability Application Programming Interfaces “API”

The API meets CMS interoperability standards, maintains privacy and compliance, and empowers members to manage their own data, supporting digital health innovation and enhancing the healthcare experience.

The CMS Interoperability final rule requires impacted payers (specifically, Medicare Advantage [MA] organizations, state Medicaid and Children’s Health Insurance Program [CHIP] Fee-for-Service [FFS] programs, Medicaid managed care plans, CHIP managed care entities, and Qualified Health Plan [QHP] issuers on the Federally Facilitated Exchanges [FFEs]) to implement and maintain:

  • A Provider Access API to share patient data with in-network providers with whom the patient has a treatment relationship.
  • A Payer-to-Payer API to enable data sharing between payers when a patient changes payers or has two or more payers at the same time.
  • A Patient Access API that allows patients to easily access their claims and encounter information.
  • A Prior Authorization API to support electronic prior authorization (ePA) workflows.

This functionality is currently only available to members of health plans under certain government programs. You may use the APIs to share data if you are a member of any of those plans.

  • You control whether we request your health care data from your previous insurer or exchange data with your concurrent insurer(s) or a third-party application [app] through the API and can “opt in” at any time. This means your data is not shared through the API automatically – you decide when and if API data sharing is allowed.
  • Opting into data sharing has several potential benefits, which could include better coordination of your care, improved completeness of your medical records if you change insurance carriers, reduction in care disruptions, improved continuity of care, better outcomes, and a better overall health care experience.
  • If you “opt in” to having your data shared through any of the APIs, you can choose to opt back out again at any time.
  • Your health care data is protected by privacy and security measures. Humana considers personal health information confidential. We protect the privacy of that information in accordance with federal and state privacy laws, as well as our Privacy Policy . Please refer to your Notice of Privacy Practices for more information on how we may use and disclose information about you in administering your plans and your rights regarding such information.
  • The Health Insurance Portability and Accountability Act (HIPAA) is a federal law. One part of it helps protect personal health information. The U.S. Department of Health and Human Services (HHS) OCR enforces the HIPAA Privacy, Security, and Breach Notification Rules, and the Patient Safety Act and Rule. You can find more information about patient rights under HIPAA opens in new window and who is obligated to follow HIPAA.
  • If you think your HIPAA privacy rights were violated, you have options:
  • Learn more about the technical specifications of the API opens in new window or if you are a developer interested in gaining access to our data for your applications. 
Patient Access API

The patient access API will allow Humana members to securely access their health data through third party applications of their choice. It provides claims, encounter details including cost and provider remittances and enrollee cost-sharing, and other clinical information like diagnoses, procedures, and medications.

The health data sent is not your complete medical history or a substitute for your full, official health records. The health data sent includes health data about you held by Humana as your health plan under parts of certain government programs, like Medicare, Medicaid, or Qualified Health Plans on the Federally Facilitated Exchanges. The health data sent may not include data Humana may have about you as a member of one of its commercial health plans.   

Important things to know about the Patient Access API Data Exchange: 

  • Be careful when choosing an app to receive your health information.
  • Humana doesn’t control how third-party apps use or share your information
  • Humana doesn’t review third-party apps or their privacy and security standards for your health data.
  • Choose apps with strong privacy and security standards.
  • Always read the apps’ terms of use before using it.
  • The app should have a privacy policy that is easy to read and easy to understand.
  • The privacy policy should explain how the app will use your information.
  • Some apps may share your health information with other companies or people.
  • If an app does not have a privacy policy, you may want to think twice before using it.

HIPAA and Third-Party Apps

Most third-party apps are not covered by HIPAA. Instead, most third-party apps are overseen by the Federal Trade Commission, also called the FTC. The FTC helps protect people from dishonest or unfair business practices. For example, an app may be acting dishonestly if it says it will not share your personal data, but then shares without your permission. The FTC provides information about mobile app privacy and security for consumers here: FTC information about mobile apps opens in new window

Questions to Ask Before Using an App

Before you share your health information with an app, read the app’s privacy policy.

Make sure it answers these questions:

  • What health information will the app collect?
  • Will the app collect non-health information from my device, such as my location?
  • Will the app store my information without my name or other details that identify me?
  • How will the app use my data?
  • Will the app share my information with others?
  • Will the app sell my information for any reason, such as advertising or research?
  • If the app shares my information, who will it share it with and why?
  • How can I limit how the app uses or shares my information?
  • How does the app protect my information?
  • Could sharing my information affect other people, such as my family members?
  • How can I see my information and fix incorrect information in the app?
  • Does the app have a way for users to file complaints?
  • If I stop using the app, how do I stop it from getting my health information?
  • If I remove the app’s access, will the app delete my information?
  • Do I need to do more than delete the app from my device?
  • How will the app tell users about changes to its privacy practices?

Your Choice and Control

  • Humana will only send or receive your health information through the Patient Access API Exchange if you or your personal representative approve it.
  • Do not start the process if you do not want to share your information.
  • You are in control. Your health information is not shared automatically through the API. You must choose to allow it. This is called “opting in.”
  • After you give permission, the third-party app has 24 hours to get your health information.
  • The app may receive information from the past five years, including claim information, medications, procedures, lab tests, conditions, immunizations, or doctor visits.
  • Humana may also send information it received from other health plans through the Payer-to-Payer Data Exchange.
  • You can stop an app from getting your health information through the myHumana.com member portal. Stopping access means the app will not get new information from Humana in the future. However, the app may still keep or use information you already shared. Check the app’s privacy policy to learn how to ask the app to delete your information.

If you need help

  • If you are having trouble allowing an app to receive data from Humana, make sure Humana is listed as an approved data source in your app.
  • For questions about how a third-party app may use, share, or display your data, you should contact the app developer.
  • For questions related about how Humana can share your data with a third-party app at your request, you should call the Customer Service number on the back of your Humana ID Card or Humana Customer Care representative listed on the Member Support section of this website.
  • You do not need to use a third-party app to access your health information. You can still use your myHumana.com member portal to access your health information. Please refer to your health plan’s Notice of Privacy Practices for more information about your rights regarding such information. 
  • If you think an app has misused your data, you should file a complaint with the FTC opens in new window .
Payer-to-payer API

This health data exchange lets two health plans share your health information. This helps your care continue when you change health plans or have more than one health plan. You can ask Humana to get your health information from another health plan on our myHumana.com web portal. If you want another health plan to get your health information from Humana, you should contact that health plan first. 

Important Things to Know about the Payer-to-Payer API Data Exchange: 

 If you have a Humana plan now, you can ask Humana to get your health information from another health plan.

  • If you had a Humana plan in the last five years, you can ask Humana to send your health information to another health plan.
  • If you have a Humana plan now, you can ask Humana to get your health information from another health plan.
  • If you had a Humana plan in the last five years, you can ask Humana to send your health information to another health plan.
  • Even if you say yes or “opt-in”, we will not share your information with health plans you are not enrolled in. The API may be used to:
    • Get your information from your old health plan.
    • Share information with another health plan you have now.
    • Send your information to a future health plan, when needed.

What Information May be Shared

  • Humana will send health information we have about you from the last five years.
  • The Payer-to-Payer transmission currently shares the clinical data listed in the United States Core Data for Interoperability (USCDI) Version 3.  opens in new window
  • Health information shared could be related to sensitive conditions such as chronic diseases, communicable diseases, substance use disorders (alcohol/drug), HIV/AIDS, sexually transmitted diseases, genetic information, reproductive health and other personal health information (PHI) about behavioral health. 
  • The information shared may not be your full medical history. It should not replace your full, official medical records.
  • Humana may also share information it received from other health plans through the Payer-to-Payer Data API Exchange.

You Are in Control

  • Humana will only send or receive your health information through the Payer-to-Payer API Data Exchange if you or your personal representative approve it.
  • Do not start the process if you do not want to share your information.
  • Your health information is not shared automatically. You choose if and when to share it.
  • This is called “opting in.”
  • Coming Soon: How to transmit health data FROM Humana to other health plans.

Transmitting health data to Humana

Current members of relevant Humana health plans will use their member web portal (myHumana.com) to start the Payer-to-Payer data transmission. You will need your other health plan's information found on that health plan's ID card. If you don't have this information, you should contact your other health plan to get it. You will also need an active login ID and password for your myHumana account. If you do not have a login ID and password, you can create one at myHumana.com.

Follow the steps below to direct Humana to receive your health data from another health plan.

  1. Log into your MyHumana.com opens in new window member web portal.
  2. Click into Account.
  3. It is recommended to contact your other health plan and have as much of this information ready as possible before beginning the transmission process. Not all of the information may be needed to match your data to your identity.
    • Member ID Card Number (preferred)
    • Issuer/Payor Name
    • Group and/or Subgroup
    • Plan and/or Subplan
    • Coverage Start and End Dates
  4. In Account, select Communication Preferences.
  5. Provide your consent for Humana to receive your health data from the other/former health plan. Under Connect your insurance records – select “Yes” for “Allow Humana to ask for your health information from previous insurance companies.”
  6. Search for your former/other health plan using the exact name from that health plan's ID card: If the insurance company you are looking for is not displayed, it may not currently be available through the Centers for Medicare & Medicaid Services (CMS) national registry or through available connectivity. We do not have an estimated timeframe for future availability. You may check again at a later date, as available connections can change over time."
Provider Access API

The Provider Access API helps Humana share your health information with doctors and other providers in your plan’s network. This helps your providers work together and take care of you.

Important Things to Know about the Provider Access API Data Exchange: 

  • Sharing your health information can help your provider:
    • Better plan your care.
    • Improve prior authorization processes.
    • Help you get care in a timely manner.
    • Help you achieve better health outcomes.
    • Improve your overall health care experience.
  • Your health care data is only available to in-network providers whom we have determined to have a record of caring for you.
  • Humana may share some heath information from your member record. This may include:
  • Health information shared could be related to sensitive conditions such as chronic diseases, communicable diseases, substance use disorders (alcohol/drug), HIV/AIDS, sexually transmitted diseases, genetic marker information, reproductive health or behavioral health.
  • The health data Humana sends through the Provider Exchange may not reflect your complete medical history and should not be used as a substitute for your full, official health records. 

You Are in Control

  • You are already included or “opted-in” in this information sharing.
  • This means your health information automatically shares with your provider.
  • You control who has access to your health information through the API and can decline or “opt out” of API data sharing at any time.
  • We have included information about how to opt out of this data sharing, as well as how to opt back in to data sharing, should you so choose. Learn more about how to OPT OUT.
  • If you opt out of API data sharing, existing laws, such as HIPAA or state law, may still allow your provider to request and receive certain information they need to treat you. 

API Opt Out

Humana can share some of your health information with doctors and other health care providers in your network. We share it through a safe electronic tool called the Provider Access API. This sharing helps your health care providers work together and make informed choices about your care.

You have the right to say no to sharing your information through the Provider Access API. This is called opting out. If you opt out:

  • Humana will not share your information through the Provider Access API under this federal program.
  • Your choice applies to all providers who would get your information through the Provider Access API. You cannot choose only certain providers.
  • Your choice will not change your benefits, your health coverage, or your ability to get health care services.
  • Your information may still be used or shared in other ways when the law allows or requires it. This may include payment, health plan operations, public health activities, or other reasons allowed by federal or state law.
  • You can read Humana’s Notice of Privacy Practices  to learn more about how your health plan may use or share your information.
  • You may change your choice at any time by contacting the Customer Service number on the back of your Humana ID Card or Humana Customer Care representative listed on the Member Support section of this website. We will process your request within 10 business days, or as soon as we reasonably can after we receive it.
  •  You may also change your Consent from “Yes” to “No” for the question “Do you want to share your data with your provider?” on the preferences section of the myHumana member portal.
Prior Authorization API

To facilitate care coordination, the Prior Authorization API helps your doctor and Humana share information faster.

It lets your doctor check if Humana needs to approve a service before you get it, called a prior authorization. The API will create an electronic workflow to allow providers to determine whether a prior authorization is required, identify what paperwork or information is needed, and receive decisions from providers within their own Electronic Health Record (EHRs) or computer systems. Your provider will choose to connect with Humana to use this tool.

This can help:

  • Save time
  • Reduce paperwork
  • Avoid delays
  • Make the process easier for you and your provider