Interoperability APIs

Interoperability APIs (application programming interfaces) enable Network Health to share medical records, claims, and prior authorizations over secure, standardized and fast connections with our members, providers and other health plans.

We work together for positive outcomes like improved continuity of care, faster prior authorizations, member empowerment and reduced healthcare costs. Our interoperability APIs meet CMS interoperability requirements including HL7 FHIR and OAuth 2.0.

Patient Access API

The Patient Access API gives Network Health members access and the ability to share their health plan data via an API endpoint with third-party applications of their choice. It meets CMS interoperability requirements and makes claim, encounter, clinical data and prior authorization information available.

Members can click here for additional information.

See Interoperability FAQs here.

Payer-to-Payer API

The Payer-to-Payer API enables Network Health members to share their health plan data with another payer when switching health plans. It meets CMS interoperability requirements and makes claims and encounter data (excluding provider remittances and enrollee cost-sharing information) and prior authorization information (excluding those for drugs and those that were denied) available. Members must opt in to share information with another health plan.

Members can click here for additional information.

Payers looking to exchange data with Network Health can contact us at ConnectInquiry@networkhealth.com.

Provider Access API

The Provider Access API enables providers to request a member’s clinical data from Network Health when there is an active treatment relationship. It meets CMS interoperability requirements and makes claims and encounter data (excluding provider remittances and enrollee cost-sharing information) and prior authorization information (excluding those for drugs) available. Members may opt out of this data sharing.

Members can click here for additional information.

Providers looking to exchange data with Network Health can contact us at ConnectInquiry@networkhealth.com.

Prior Authorization API

The Prior Authorization API automates the process for providers to determine whether a prior authorization is required, identify prior authorization information and documentation requirements, and facilitates the exchange of prior authorization requests and decisions from provider electronic health records (EHRs). It meets CMS interoperability requirements and reduces administrative burden.

Providers looking to make requests over the Network Health Prior Authorization API can contact us at ConnectInquiry@networkhealth.com.

Provider Directory API

The Provider Directory API provides provider directory information via a public facing endpoint on Network Health’s website. It meets CMS interoperability requirements and allows for real-time sharing of our provider network.