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.
โ€‹DaVinci PDEX Plan Netโ€‹
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:

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Last modified 2mo ago