Interoperability & Patient Access Rule

On May 1, 2020, the Department of Health and Human Services (HHS), through the Centers for Medicare & Medicaid Services (CMS) and the Office of the National Coordinator for Health Information Technology (ONC), issued a rule to improve secure, authorized access to health and insurance data.

Sharing of this information empowers our members with access to their health and insurance information through whatever device or app they choose, allowing caregivers and insurance carriers to work together to best serve our member’s healthcare needs.

Connecting multiple health record sources

In spite of advances in health care technology, including electronic records, there is not an easy or readily available process to connect multiple health care organizations (i.e. doctors, hospitals, clinics, health insurers, and pharmacies.) These new measures will open doors for options to enable health information systems to work together to deliver health care information for patients that can help ensure effective delivery of the best and most affordable care.

Improving health care

5 key benefits of achieving interoperability (Becker’s Health IT) include:

Improved care coordination and patient experiences
Greater patient safety
Stronger privacy and security for patients
Higher productivity and reduced healthcare costs
More accurate public health data

How MyAdvocate Medicare Advantage is collaborating for interoperability

MyAdvocate Medicare Advantage is committed to ensuring interoperability links and the required data are available within the required application-programming interfaces, or API. Data within the APIs enables members to access their health data via a third-party application of their selection.

Protecting your data

InterSystems Corporation maintains and supports MyAdvocate Medicare Advantage’s Patient Access API, which has been designed to provide secure and efficient access to health data while maintaining the highest standard of data protection.

MyAdvocate Medicare Advantage also understands that your privacy and protection of data is important. Educational resources on the protection of personal health information and how to submit a formal complaints can be found on our Privacy of Health Information page.

If you are an application developer or vendor and would like to request access to members’ health information using a Patient Access Application Programming Interface (API), please view our API Access Agreement and email us your request.

Patient Access API Developer Information

As part of MyAdvocate Medicare Advantage’s commitment to transparency and accessibility, comprehensive technical documentation for our APIs is freely accessible to the public at InterSystems developer site.

As mandated by the U.S. Centers for Medicare & Medicaid Services (CMS), the Patient Access API meets the specification as outlined in the CARIN Consumer Directed Payer Data Exchange (CARIN IG for Blue Button) Implementation Guide and the DaVinci Payer Data Exchange (PDex) US Drug Formulary Implementation Guide and conforms to the technical standards for data exchange via secure API. Please reference these sites for more information or email us your questions as MyAdvocate Medicare Advantage does not support developer-specific questions.

Interoperability Base URLs for MyAdvocate Medicare Advantage data

Provider Directory API (Coming January 2026) – Contains MyAdvocate Medicare Advantage provider directory information.
Patient Access API (Coming January 2026) – Secure sharing processed claims, encounters and clinical data that are maintained by MyAdvocate Medicare Advantage.
Medicare Advantage Formulary API – Drug Formulary data that enables members to see which medications are covered by their Medicare Advantage plan.

BESHP, Inc. (MyAdvocate Medicare Advantage), is an HMO-POS plan with a Medicare contract. Enrollment in BESHP, Inc. depends on contract renewal. BESHP, Inc. complies with applicable federal civil rights laws and does not discriminate, exclude or treat people differently on the basis of race, color, national origin, religion, pregnancy and related conditions, sex (including sexual orientation, gender identity, sex stereotypes, sex characteristics and intersex traits), age, disability, health status, marital status, arrest or conviction record or military participation in the administration of the plan, including enrollment and benefit determinations.

CMS ID Number: H0816_MyAMAWebsite_07-25_NE_M