Interoperability Provider Directory API Provider v1
As part of the CMS Interoperability and Patient Access final rule (CMS-9115-F), payers must make provider information available. These APIs are required to retrieve the provider information directly.
There are nine provider resources that conform to the HL7 FHIR standards. These resources provide information on providers and pharmacies within the specific payer's network. Note that four of these resources also appear in the Clinical section.
More details on this API can be found in the Capability Statement API as well as in the swagger document.
APIs in this category follow the PDEX Payer Network Implementation Guide v1.0.0 found at https://build.fhir.org/ig/HL7/davinci-pdex-plan-net/profiles.html.
See the Security section on this portal to learn more about securely using our APIs.
Plan Net Endpoint
Provides technical details related to Endpoints that is used for electronic services.
Endpoint API returns fields including extension, Status, Connection Type, name, contact, Payload type, payloadMime Type and Address(Url).
Plan Net Healthcare Service
Plan Net Healthcare Service API covers data related to a HealthCare Service and services provided by an organization at a specific location.
The HealthCareService resource typically describes services offered by an organization/practitioner at a location. The resource may be used to encompass a variety of services covering the entire healthcare spectrum, including promotion, prevention, diagnostics, hospital and ambulatory care, home care, long-term care, and other health-related and community services.
Plan Net Insurance Plan
An InsurancePlan provides health insurance coverage benefits which are offered under a network type.
InsurancePlan API offer health insurance list comprised of covered benefits (product), Plan, administered by, coverage area, contact information etc..
Plan Net Location
Plan Net Location API providers detail position/location information of the physical place that is associated with a patient, Provider or organization. Location may include private, public, mobile or fixed. Location examples are Building, wards, room, mobile clinic, vehicle, parking place, ambulance etc.
Plan Net Location API return fields including status ( active, suspended, Inactive), name, telecom, address and managing Organization (organization responsible).
Plan Net Network
A network is basically a healthcare Provider insurance network. A healthcare provider insurance network is a set of organization and indivudual that provider set of service through insurance plans/product.
Network API returns feilds including Organization Name, Healthcare Provider, Address, Telecom and PartOf (The organization of which this organization forms a part).
Plan Net Organization Affiliation
Organization Affiliation defines a relation between two separate business entities.
Plan Net Organization Affiliation API returns fields inculding Organization, Participating organization, Period, active (organization affiliation record is in active use), Network and location.
Plan Net Organization
The Organization resource describes a grouping of people or business entities relevant to the healthcare process. Organizations include hospitals, employers, insurance companies, physicians’ offices, rehabilitation facilities, laboratories, etc.
Plan Net Organization API returns fields including Organization Identifier, Active (whether organization is active), type (Type of organization), name, contact Information and address.
Plan Net Practitioner
The Plan Net Practitioner API provides information about a person formally involved in the healthCare process and healthCare- related services on behalf of a healthcare facility. Practitioners include and are not limited to physicians, nurses, pharmacists, therapists, technologists, and social workers.
The Plan Net Practitioner API returns fields including Practitioner ID, NPI, Name, Address and profile information.
Plan Net Practitioner Role
Plan Net Practitioner Role API covers data related to type of services that a practitioner provides for an organization. Plan Net Practitioner Role API returns fields including Practitioner, Organization (Organization where the roles are available), code (role of the practitioner), specialty ( Specialty of the practitioner), location (The location(s) at which this practitioner provides care), telecom (contact details).
|API Name||API Version||Date Introduced||Available Until|
|Interoperability Provider Directory API Provider||v1||12/28/2020||Current|
- Initial release.