The CMS Interoperability and Patient Access final rule requires MA organizations, Medicaid FFS programs, CHIP FFS programs, Medicaid managed care plans, and CHIP managed care entities to make provider directory information publicly available via a FHIR-based Provider Directory API.
Provider directories play a key role in enabling the identification of individual providers and provider organizations within a network. The Provider Directory API enables a member to use a third-party application to access information about in-network providers and provider organizations. The Provider Directory API is an open-access API and does not require authentication to access the data.
Opala's Provider Directory API supports the Da Vinci PDEX Plan-Net standard for search and retrieval, based on FHIR R4. The provider directory uses a push service to send new records and updates to the FHIR Repository. This documentation assumes that the developer is familiar with the Da Vinci PDEX implementation guide for a provider directory.
Use the following URL to request data from Opala’s Health Plan Provider Directory API:
https://opala.tech/provdir/premera/v1/fhir-r4
Use the following URL to request data from Opala’s PBM Provider Directory API:
https://opala.tech/provdir/navitus/v1/fhir-r4
Use the following URL to access Opala's Health Plan Provider Directory API public metadata:
https://opala.tech/provdir/premera/v1/fhir-r4/metadataUse the following URL to access Opala’s PBM Provider Directory API public metadata for a description of the Provider Directory API to assist you in making your queries:
https://opala.tech/provdir/navitus/v1/fhir-r4/metadataThe Health Plan Provider Directory makes in-network providers available under a single endpoint. The FHIR repository includes these resources:
The PBM Provider Directory makes in-network pharmacies available under a single endpoint. The FHIR repository includes these resources: