Da Vinci PDex Plan Net
1.2.0 - STU1.2 United States of America flag

This page is part of the DaVinci PDEX Plan Net (v1.2.0: STU 1) based on FHIR (HL7® FHIR® Standard) R4. This is the current published version in its permanent home (it will always be available at this URL). For a full list of available versions, see the Directory of published versions

Background

Page standards status: Informative

Background

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, including:

  • Patient/Payer focused
    • Find provider accessibility information (specialty, office hours, languages spoken, taking patients) - enables individuals and consumers to find contact and other accessibility information for individual healthcare providers and/or healthcare organizations
    • Relationship between provider and insurance plan (insurance accepted) or plan and provider (network) - enables individual healthcare providers, organizations, and payers to discover the relationships between providers, organizations, and payers, as well as additional details about the relationships and entities involved
  • Basic Information Exchange
    • Enable electronic exchange (e.g. discovery of electronic endpoints such as IHE/EHR endpoints, FHIR server URLs, Direct addresses) - enables the electronic exchange of health information by supporting the ability to discover electronic service information including electronic endpoints or electronic addresses
    • Find an individual and/or organization (even if no electronic endpoint is available) - enables users to find contact and other identifying information about healthcare organizations and individual healthcare providers


This IG addresses two actors:

  • Health Plan API Actor: A payer publishing a directory of its provider networks through a FHIR endpoint.
  • Application Actor: A third party using the API published by a payer to provide useful views of the payer's provider networks for end users.

For anticipated query use cases, please see Representing and Searching Provider Data.