Health and Safety Code section 130290(b)(1), requires that required signatories to the DxF Data Sharing Agreement, which includes health insurers and health care service plans, Exchange health information or provide Access to health information to and from every other required signatory. Health and Safety Code section 130290(a)(4) defines “health information” for health insurers and health care service plans as, “at a minimum, the data required to be shared under the federal Centers for Medicare and Medicaid Services Interoperability and Patient Access regulations for public programs as contained in United States Department of Health and Human Services final rule CMS9115-F, 85 FR 25510.” The referenced Centers for Medicare and Medicaid Services final rule requires entities to share adjudicated claims, encounter information, and clinical data contained in USCDI. (42 C.F.R. § 422.119.)

Note, under the DxF, cost information may be excluded from adjudicated claims and encounter information except when providing Individual Access Services. (Data Elements to Be Exchanged Policy and Procedure, Section II.1.iii.)