Health and Safety Code (HSC) § 130290, subdivision (b)(1), requires that mandatory signatories to the Data Sharing Agreement (DSA), which includes health insurers and health care service plans, exchange health information or provide access to health information to and from every other mandatory signatory. HSC § 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 CMS-9115-F, 85 FR 25510.” The referenced CMS final rule requires entities to share adjudicated claims, encounter information, and clinical data contained in the US Core Data for Interoperability. (42 C.F.R. § 422.119.)

Note, under the DxF, cost information may be excluded from adjudicated claims and encounter information except for Individual Access Services while retaining the requirement to share adjudicated claims, encounter information, and clinical data without cost information for DxF Participants. (Data Elements to Be Exchanged P&P, Section II.1.iii.)