California DxF provider participation

As you are aware, beginning on January 31, 2024, the California Health and Human Services (CalHHS) enacted the Health and Human Services Data Exchange Framework (DxF), a first-ever, statewide data sharing agreement, which aims to accelerate and expand the exchange of health information among health plans, health systems and provider organizations, government agencies, and social service programs.

In addition to submitting the required Health Equity and Quality Measure Set (HEQMS) with Anthem as described in our communication dated May 16, 2024 (Health Equity and Quality Measure Set reporting - Provider News (anthem.com), Anthem will now be able to share clinical and claims data for your patients. In this new data exchange framework, unless a member has opted out of sharing their claims and clinical records with the providers, they receive care and treatment from, we can now provide you with pertinent patient data when requested to guide patient care. The goal of DxF is to ensure providers have access to the best information possible to deliver high-quality care and optimize treatment for your patients.

We invite you to participate and access the information to:

• Treat the patient quickly and safely.
• Connect health care, behavioral health, and social services agencies to deliver an integrated model to manage the health of Californians.
• Assess how the public health system can better address the needs of all communities.

How to Participate in DxF?

Providers may register as described below:

1. Effective September 4, 2024, providers can register with Anthem using the Availity Payer Space (Availity Essentials) tile Data Exchange Framework following the below steps:

1. Provider selects the Data Exchange Framework payer space tile.
2. Provider lands on the registration form and fills in certain information and submits the form. Details on how to register can be found in https://rebrand.ly/4025117.
3. A submitted form will go into a pending state, and the Interoperability operations team will review the form and approve it.
4. Once approved, the provider can go back to the registration website for Anthem and request the credentials to connect with Anthem and request the member’s clinical and claims data.

The registration approval as described above may take two to four weeks.

We have included a General and Technical Frequently Asked Questions section to reference in this communication.

If there are any questions related to the onboarding, please reach out to: InteroperabilityWorkgroup@anthem.com.

Additional information on DxF is available in the Frequently Asked Questions below and at the following link: cdii.ca.gov/committees-and-advisory-groups/data-exchange-framework/

General and Technical Frequently Asked Questions

General FAQ

Note: Please check the Technical FAQ section for all the technical and specification-related questions.

1. Where can I find more information on the California Data Exchange Framework (DxF)?
   All the relevant information related to CA DxF can be located on the below state website: cdii.ca.gov/committees-and-advisory-groups/data-exchange-framework/
2. What data can providers expect to receive?
   Anthem will share the clinical and claims data for our members that are being cared for by our provider partners. Please check out the Technical FAQ section for technical specifications used in the data exchange.
3. Do I need to get consent from members to receive the data?
   No, providers do not need to receive consent from members to access their data through DxF. All member information, except sensitive data, is automatically available in the data set available to providers. As per 42 CFR Part 2 and California state health data sharing guidelines, member consent would be required if the request includes access to sensitive data (for example, HIV, reproductive, behavioral, and substance use disorder).
4. Can the member opt out of the Data Exchange Framework?
   Yes, if a member opts out or refuses to share the data, Anthem will not provide the data for that specific member.
5. Can I test with Anthem before connecting in production?
   Yes, the entities can register and test on our sandbox environment using the instructions on: https://totalview.healthos.elevancehealth.com/fhir/documentation#overview-section

Technical FAQ

1. Is there a technical document that highlights the capabilities supported by Anthem?
   Our APIs and technical documentation can be accessed here:
   https://totalview.healthos.elevancehealth.com/fhir/documentation#overview-section
2. What standards does Anthem use to exchange the data?
   Anthem supports the FHIR 4.0.1 standard to enable the data exchange. 
3. What technical specifications does Anthem use for the data exchange?

• Inbound Request Format: For an inbound request, please use the Hrex Technical Specification. The structure of the inbound request is also provided in the API/technical documentation provided above.
• Consent Specification: For receiving the consent, Anthem will be using the Hrex-Consent profile. Consent is enabled using the policy field in the consent profile. The structure of the consent is also provided in the API/technical documentation provided above.
• Clinical Data Payload FHIR Specification: A payload containing claims and clinical data as defined in USCore 5.0.1(USCDI V2) will be returned to the requester.