Provider Directory API
Definition
A Provider Directory API is a public, standards-based way for apps to read a health plan's provider directory. CMS interoperability rules require it for Medicare Advantage, Medicaid and CHIP plans, using HL7 FHIR and the Plan-Net format.
By the Candor Health team
Last reviewed
Also called provider directory APIs and Plan-Net
Who has to publish one?
CMS's interoperability rules require Medicare Advantage organizations and state Medicaid and CHIP programs and their managed care plans to make their provider directories available through a FHIR API.
What format does it use?
The HL7 Da Vinci PDex Plan-Net implementation guide, which defines how practitioners, locations, organizations, networks and plans are represented.
What can developers do with it?
Build find-a-doctor tools, compare networks and check whether a provider is in a plan. The results are only as good as the directory data behind the API.