Interoperability Provider Directory API - Provider

Product Overview

Provider-related resources include insurance plan information, locations, healthcare services, and networks required to deliver provider directory information. Provider directory information also includes pharmacies.

Product Description

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

Getting Started

Per the Regulation, the Provider Directory APIs are provided without authentication requirements. After validating your connectivity with the sandbox, please use the below details to connect to our Production APIs:

The URL for our Provider Directory Production endpoints adhere to the following format, where APINAME is replaced with the name of the API you are attempting to call:

https://apis.changehealthcare.com/anon/CMSPatientAccess/provider/v2/APINAME

So for example, the Practitioner API can be called from:

https://apis.changehealthcare.com/anon/CMSPatientAccess/provider/v2/Practitioner

Importantly, our Provider Directory APIs require the submission of "CHC Payer ID" parameter, where CHCPAYERID in the example below is replaced with the ID of the payer you are wishing to access (see Table below for full list of Sandbox and Production Payer IDs):

https://apis.changehealthcare.com/anon/CMSPatientAccess/provider/v2/Practitioner?chc-payer-id=CHCPAYERID

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Click here to learn about Sandbox Availability.

Payer IDs

To query the directory of specific payer, please refer to the table below for the Payer ID parameter that can be used in the Provider Directory APIs.

Payer NamePayer ID (Sandbox Use)Payer ID (Production)
Agewell New York659602387A50487F9D0099BF628C036EA83FE8926A784807AED2EE698D7D41C8
Alliant Health Plan0A2FBCCBCD1341758CBD3D19CA38B67769553C6F4A7D498C87C86E2FA72162EA
Allways Health Partners73D38B65094C4532B31C1AE21ECAED78F33CA6DE52084BFD93E761EE0949659A
Aspire Health1C7758BDDEE041CA9E05B191F76DC4D8454E77479DA74A4489C27F3B5614DF6B
Aspirus HealthF4CF82752C544E108FE64A1B768A75297FD6224C2EC140B7A5C98987CAA984B0
AultCareBB553EF425D311EB83A6124E422C9EF10261E37C54644A76838DDDB7074FC411
BayCare Health Plans089E6BC649154164BF35A9F75D731862A665620511BE49B0BB5AE9663E2FAEFB
Health Team Advantage8FE3FDF60C1A4FA09C6FB2D38D27BB0835CA33CD8947488BA18A605D0B506AD5
Cascade Comprehensive Care226F3FCD943843A5B696C0F162D586AA0A320B325A40404E93E76E2DFDC64A30
Christus Health Plan3FA7DF8754AC4C6A87576F506B15C6FDA5F4CD753970481E875D0C5C09B78CC3
Clear Spring Health895CF21043C84A619470CACF72D7DB202EBEDCFEC6DF4DD38C154463E48530F3
Common Ground Healthcare CooperativeA40F1A3474AA4F0AA1E43B185845F47C174690E0EDC94052800823F72927EA9A
Community Care Inc.10764EE705B24D96ABF58A1E78FA75926E4E36FB80464838905AA540C774E676
Cox Health PlanD697A4D7543C4700A70C5A55EFE01DD39B47D1AE0461464AA12C8B418D023112
Doctors Healthcare Plans6406440EB69D468DA4214E9C541E4A0D6178ABF0FFD3488FAB4EB7FAFB39C6F0
Driscoll Children's Health Plan53BCD52D2D664E2CA5A475E40A22AE8732487A105D064243A0E76E1904F89E23
El Paso Health8CD1A590350B47E69BF44247AF189DCBA248E96D53254728A2BA159AA3F99D70
Essence Healthcare Advantage Plans40411026C2AA4C7E8A16BA649233DD73EFD807C6404942F3BCCAB8E9D1BE030A
Fallon Community HealthE31BC5F26FCD4604A7B5E537D90807C30F2BE00379DA493DAED7DF50230C43CC
Freedom Health PlanFF4BE0D6D861444AA8B3C6797D1DE3C7EA3E20C2ADCB44CF81D9882C7D83CBFD
Gateway Health Plan28853FF7DD1B4DD1BC4680E62EBBAE62C16CB396782849198C7E17606E0EFE67
Global Health8E661FD116044898B4232A44BAE5AE23E77AB398A16F46CD91B8FC10D593AD2B
Health First Health Plan75C106CD845D467DB78AE7C060C5A5BB88F6F4C98E4B427484F0E9EFFC19F60D
Health Sun5E1E6D6EA57440B6A30093614520A98D5AA8E68CC2ED4E30B18B6DC198534FA2
Hometown Health PlanD917EFECF68A4ED6B06135FF41C3EF05E001CF16A36E4246B02363ACA717FD4A
Independent Living Systems7616A5EC4B344DEBA0B2A24DDC57B45F274D24650F564E41A820EA52809FDAD4
Indiana University Health Plans2B25CFE52F3B11EB83A6124E422C9EF1F8124FB4CA864400983DDA6C27B7F35E
Johns Hopkins - AdvantageMD6918AA98A6654AC2A14C73EE7CF11AC3AC29F5DAC03E4135A5A9A48D99229435
LA Care9C51A8B521634DD8B0E2F3A8C192251FF808CEFEB14044E4A16A0F5B63AC0BCD
Leon Health6D7701B507774E58B36E1C70067F6553TBD
Lumeris267161FD098B11EB83A6124E422C9EF1AFD1B2B3DA864FBB94BFE4E248186AB0
Mary Washington Health PlansECA9417B2B8E4E61AB9C125B9CA45AD568AD95D5FA6940DEB54B0DDA71C7297E
Maryland Physicians CareF04E372145E54A2E9734E701769BE14C2078DF3D858B4ED592E89EBF891CF452
My Choice Wisconsin4A13EAC43F4442D5A70FBF11C1207CA8908E30FEB98848BD854DEA6DF3A68399
Nascentia Health Inc416DB822AA974709B52C79E6DC8F168588B47DA170E54C778D3DD34014ED80E2
Network Health Plan443224A36B2845D28B7AA818ECC6198CTBD
Optimum Healthcare910FF74C3B22431098D672DB25FC61B0E645709AE4B0469F82273E8030617ECD
Physicians Health Plan Medicare07AE89BA7CA144B1949061F45E978ACC8AC6CF8123404F0EAF126FD6ABEA22A8
Physicians Health Plan Sparrow8B804259353A45448D9C79A2CA5830D062F709CF9EDE4B718E50C97BCA29A969
Johns Hopkins - Priority Partners6918AA98A6654AC2A14C73EE7CF11AC3AC29F5DAC03E4135A5A9A48D99229435
RAM Technologies204644834C054166988267AF2EB5FA465F2DA3C7FA944F70A7157F319B0DF502
Sendero Health Plan5EA2BAF3CF7045159514C7E91C24B52858E62055568B485A947D77EB321ACC41
Stanford Healthcare Advantage Plan64A437F22BBA4037B8DB8D46852136E47BDF3145E2E94A33AC24A5CB62A0575D
Texas Children's Health PlanF64158E7883E4950BB2314A6A52EC54F6DCAB8371F5F4B31A480EB445817F72C
The Health Plan of West VirginiaD9062EE4542E40319AEFBDBE660DF7E4FC7DDBF9905841DEB0A4552534744117
UCare367F8DC1E0364CF188166951DF9A362F0AE6F8F678C8434AB500EC0BAA29EFCC
Viva Health62DCE6B01F8011EB83A6124E422C9EF1FE1BB605C6BF41C581EC0B80A3A8D5E9
Vivida Health68AC266D08A7441FB52C72E76114B207TBD
Yamhill Community Care Organization YCCOF8D39E90073F4E0B90B87E697C2B7C66E6C9787E21844243B00B6B17647F3881
Change Log
View our Change Log/Release Notes for more information on this API