Provider Directory

Access information about Insurance Plans, Coverage, Network

What is a provider directory?

Provider directory access is a supported feature in Sero, contact fou[email protected] if you need provider directory data
Provider directories are databases containing information about insurance plans, practitioners (like doctors and specialists) and their roles (the specific services offered).
Provider directories play a critical role in enabling identification of individual providers and provider organizations, as well as characteristics about them. Provider directories support a variety of use cases.
Provider directories help to answer questions about:
  • Finding specialist service providers for specific medical services
  • Which providers, primary care doctors, specialists, pharmacies, facilities are "in network" for a given plan
  • Accessibility and scheduling information, office hours, spoken languages
  • Organizations that provide health care services, available insurance plans, coverage locations

How do provider directories work?

In the United States, CMS regulated health plans are required to publish a public-facing FHIR API. Major plan payers like Humana, Aetna, and Optum have implemented a specific API called Da Vinci PDex Plan Net.
Provider directories typically implement these FHIR Resources:
These are made available for third party application developers to query against. You can use the Sero Client library to easily make paginated search queries to these provider directories.
A simple illustration of the architecture:
An example Plan Net architecture implementation of a Provider Directory
Try out this example with a real Provider Directory API and the Sero toolkit: