Interoperability and Patient Access 

In 2021, a new federal rule made it easier for members* to manage their digital health records. This rule is called the Interoperability and Patient Access rule (CMS-9115-F) and makes it easier to get your health records when you need it most. 

You now have full access to your health records on your member portal, at no charge. This allows you to manage your health better and know what resources are available to you. 

Provider Directory information is available through your member portal. This is in a machine-readable format. 

Imagine: 

• You go to a new healthcare provider because you don’t feel well and you can show that provider your health history from the past five years 

• The provider uses that information to diagnose you, and you quickly find the right specialist by checking an up-to-date provider directory 

• You have a question about a claim, so you go to your computer or mobile device, and, in minutes, you see if it’s paid, denied, or still being processed 

• You can take your health history with you as you switch health plans 

The new rule makes it easy to find information** on: 

• Claims (paid and denied) 

• Pharmacy drug coverage 

• Specific parts of your clinical information 

• Healthcare providers 

*Beginning in 2022, the Payer-to-Payer Data Exchange portion of this rule allows former and current members to request that their health records go with them as they switch health plans. For more information about this rule, view the Transition of Care Policy. 

**You can get information for dates of service on or after Jan. 1, 2016. 

Patient Demographics 

• First name 
• Last name 
• Previous name 
• Middle name 
• Suffix 
• Birth sex 
• Date of birth 
• Race 
• Ethnicity 
• Preferred language
• Sexual Orientation

Allergies & Intolerances 

• Substances (medications) 
• Substances (drug class) 
• Reaction 

New Demographics 

• Current address 
• Previous address 
• Phone number 
• Phone number type 
• Email address 

Health Concerns 

• Immunizations 
• Procedures 
• Medications 
• Laboratory Tests & Results 
• Assessment & Treatment Plan 
• Care Team Members 

Having your health information in one place may help you and your providers: 

• Understand your health better 

• Make better decisions 

• Improve your health outcomes 

• Reduce healthcare costs 

• Carry information to new providers or health plans 

Register and create a member portal 

• Visit the AlohaCare Member Portal

• Member Registration Process is a two step process 

• Member Verification step & Account creation  

If you are a new member, we want to make sure you still receive the services that you need. We will help you transition into our plan. 

• We will assign you to your current Primary Care Provider (PCP) if he/she is a part of the AlohaCare provider network. 

• If your PCP is not a part of our provider network, we will invite your PCP to join our network. If your PCP applies to join our network, you can continue to see your PCP. 

• If your PCP does not want to join our provider network, we will find you a new PCP as soon as possible. 

• If you have Medicare, you don’t have to choose a Primary Care Provider (PCP) in our provider network. We will work with your Medicare PCP to coordinate your care with our plan. 

• Prior treatment and services you were receiving will be approved for the same amount that was previously approved 

If you change your PCP, we will help make sure your new PCP gets your information. We share important information that will help your new PCP provide you with better care. 

• Your list of medications 

• Your treatment and action plans 

• Your medical history 

We will help make sure that you have support as you move into a different setting of care. This includes helping new caregivers understand your medical and other care needs and that your PCP and other providers are aware of the changes in your condition. 

• When you leave the hospital, we will help you for at least the first 30 days with your transition back into your home or other care home setting. If you have a Health Care Worker or Care Coordinator, he or she will continue to assist you as long as you need it. 

• Help you understand your medical condition, recognize symptoms and develop a plan to stay healthy 

• Help you make follow up appointments and transportation if needed to see your PCP and other providers 

• Help you sort out your medications and follow your doctor’s orders 

If you leave AlohaCare, we will help make sure your new health plan gets all your information. We will help you transition your health care information over to your new health plan. We share important information that will help your new health plan continue to provide the medical care and services you already receive. 

• Your list of medications 

• Your treatment and actions plans 

• Schedule of doctor appointments 

Routine use means using your PHI in the following ways: 

• For your treatment with your doctor or other health care providers. 

• To pay doctors, hospitals and other health care providers for the care you receive. 

• To make sure you receive proper health care. 

Yes, there are some cases where we must share your PHI without your consent for non-routine use.  We may use or share your PHI in any of the following situations: 

• We may share your PHI with public health or legal agencies that work to prevent or control disease, injury or disability in Hawaii. 

• As required by law, we may need to share PHI if we suspect abuse, neglect or domestic violence. 

• We may share PHI with agencies that work to help prevent fraud and abuse and for other government activities that watch over health care. 

• We may share your PHI with law enforcement officials because of a court order, warrant, subpoena or other law process. 

• We may use or share PHI as required by the federal privacy law. 

• We may share PHI with the medical examiner or a funeral director so they can do their job. 

• We may share PHI with researchers who are approved to do research projects. 

• We may share PHI to protect the health of another person or for the public. 

• We may share your PHI with federal officials for national security activities. 

• We may share PHI to comply with laws on workers’ compensation or other programs. 

• During a medical emergency or disaster, we may share PHI to make sure you get the care or services you need. 

Unless for one of the reasons listed here, we have to get your written permission to share your PHI. You do not have to agree and authorize additional use of your PHI.  If you do agree and later change your mind, you may cancel your authorization. 

If you would like a copy of your PHI or need to request access to the PHI that AlohaCare has, please contact AlohaCare CCS Member Services at 808-450-3386 or toll-free 1-888-397-9899. TTY/TDD users can call 1-877-447-5990. AlohaCare does not keep copies of your medical records. To get copies of your medical records, please call your provider’s office and request a copy of your medical record. 

You may also make your request in writing by sending a letter to: 

AlohaCare 

Attention: Compliance Department 

1357 Kapi`olani Blvd, Suite G101 

Honolulu, HI 96814 

AlohaCare has the right to not provide copies of your PHI in certain cases.  To understand your rights, and the rights of AlohaCare, please see Notice of Privacy Practices or look at your AlohaCare QUEST (Medicaid) Member Handbook.  You can also request a copy of the Notice of Privacy Practices by calling AlohaCare CCS Member Services at 808-450-3386 or toll-free 1-888-397-9899. TTY/TDD users can call 1-877-447-5990.