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.