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

📘

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 Name

Payer ID (Sandbox Use)

Payer ID (Production)

Agewell New York

659602387A50487F9D0099BF628C036E

A83FE8926A784807AED2EE698D7D41C8

Alliant Health Plan

0A2FBCCBCD1341758CBD3D19CA38B677

69553C6F4A7D498C87C86E2FA72162EA

Apex Health

12AFCA132E24429FB1C1C19013406017

A6C60D0D65444EFE8DED268BBC91CB81

Aspire Health

1C7758BDDEE041CA9E05B191F76DC4D8

454E77479DA74A4489C27F3B5614DF6B

Aspirus Health

F4CF82752C544E108FE64A1B768A7529

7FD6224C2EC140B7A5C98987CAA984B0

BayCare Health Plans

089E6BC649154164BF35A9F75D731862

A665620511BE49B0BB5AE9663E2FAEFB

Health Team Advantage

8FE3FDF60C1A4FA09C6FB2D38D27BB08

35CA33CD8947488BA18A605D0B506AD5

Christus Health Plan

3FA7DF8754AC4C6A87576F506B15C6FD

A5F4CD753970481E875D0C5C09B78CC3

Clear Spring Health

895CF21043C84A619470CACF72D7DB20

2EBEDCFEC6DF4DD38C154463E48530F3

Common Ground Healthcare Cooperative

A40F1A3474AA4F0AA1E43B185845F47C

174690E0EDC94052800823F72927EA9A

Community Care Inc.

10764EE705B24D96ABF58A1E78FA7592

6E4E36FB80464838905AA540C774E676

Cox Health Plan

D697A4D7543C4700A70C5A55EFE01DD3

9B47D1AE0461464AA12C8B418D023112

Doctors Healthcare Plans

6406440EB69D468DA4214E9C541E4A0D

6178ABF0FFD3488FAB4EB7FAFB39C6F0

El Paso Health

8CD1A590350B47E69BF44247AF189DCB

A248E96D53254728A2BA159AA3F99D70

Essence Healthcare Advantage Plans

40411026C2AA4C7E8A16BA649233DD73

EFD807C6404942F3BCCAB8E9D1BE030A

Freedom Health Plan

FF4BE0D6D861444AA8B3C6797D1DE3C7

EA3E20C2ADCB44CF81D9882C7D83CBFD

Friday Health Plan

C67ECC0DFDBF49B8A674F35C84B2F8F1

C48DBB1592DC4125BC0A08600ED1F2D6

Gateway Health Plan

28853FF7DD1B4DD1BC4680E62EBBAE62

C16CB396782849198C7E17606E0EFE67

Global Health

8E661FD116044898B4232A44BAE5AE23

E77AB398A16F46CD91B8FC10D593AD2B

Golden State Medicare Health Plan

EE8F066F7DF94B6DBD6823F8D606AAE5

217CC2BF778A4AB0B74AB37EE2957922

Health First Health Plan

75C106CD845D467DB78AE7C060C5A5BB

88F6F4C98E4B427484F0E9EFFC19F60D

Health Sun

5E1E6D6EA57440B6A30093614520A98D

5AA8E68CC2ED4E30B18B6DC198534FA2

Hometown Health Plan

D917EFECF68A4ED6B06135FF41C3EF05

E001CF16A36E4246B02363ACA717FD4A

Independent Living Systems

7616A5EC4B344DEBA0B2A24DDC57B45F

274D24650F564E41A820EA52809FDAD4

Indiana University Health Plans

2B25CFE52F3B11EB83A6124E422C9EF1

F8124FB4CA864400983DDA6C27B7F35E

Integra Health Plan

DC067EAE52134A9CBB7C70BB2BE74052

4E27C3AD1C0B42BD8BE3C613D8D428E0

Johns Hopkins - AdvantageMD

6918AA98A6654AC2A14C73EE7CF11AC3

AC29F5DAC03E4135A5A9A48D99229435

LA Care

9C51A8B521634DD8B0E2F3A8C192251F

F808CEFEB14044E4A16A0F5B63AC0BCD

Leon Health

6D7701B507774E58B36E1C70067F6553

BB8F788099784CE393AD79C02647747A

Lumeris

267161FD098B11EB83A6124E422C9EF1

AFD1B2B3DA864FBB94BFE4E248186AB0

Mary Washington Health Plans

ECA9417B2B8E4E61AB9C125B9CA45AD5

68AD95D5FA6940DEB54B0DDA71C7297E

My Choice Wisconsin

4A13EAC43F4442D5A70FBF11C1207CA8

908E30FEB98848BD854DEA6DF3A68399

Nascentia Health Inc

416DB822AA974709B52C79E6DC8F1685

88B47DA170E54C778D3DD34014ED80E2

Network Health Plan

443224A36B2845D28B7AA818ECC6198C

TBD

Optimum Healthcare

910FF74C3B22431098D672DB25FC61B0

E645709AE4B0469F82273E8030617ECD

Physicians Health Plan Medicare

07AE89BA7CA144B1949061F45E978ACC

8AC6CF8123404F0EAF126FD6ABEA22A8

Priority Partners

6918AA98A6654AC2A14C73EE7CF11AC3

AC29F5DAC03E4135A5A9A48D99229435

Sendero Health Plan

5EA2BAF3CF7045159514C7E91C24B528

58E62055568B485A947D77EB321ACC41

Stanford Healthcare Advantage Plan

64A437F22BBA4037B8DB8D46852136E4

7BDF3145E2E94A33AC24A5CB62A0575D

Texas Children's Health Plan

F64158E7883E4950BB2314A6A52EC54F

6DCAB8371F5F4B31A480EB445817F72C

The Health Plan of West Virginia

D9062EE4542E40319AEFBDBE660DF7E4

FC7DDBF9905841DEB0A4552534744117

UCare

367F8DC1E0364CF188166951DF9A362F

0AE6F8F678C8434AB500EC0BAA29EFCC

Viva Health

62DCE6B01F8011EB83A6124E422C9EF1

FE1BB605C6BF41C581EC0B80A3A8D5E9

Vivida Health

68AC266D08A7441FB52C72E76114B207

0578E5A63F23496F9C094644066DBC0C

Yamhill Community Care Organization YCCO

F8D39E90073F4E0B90B87E697C2B7C66

E6C9787E21844243B00B6B17647F3881

Change Log

View our Change Log/Release Notes for more information on this API