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Provider Directory API

Plan-Net Network

A Network refers to a healthcare provider insurance network, which is an aggregation of organizations and individuals that deliver a set of services within an area through health insurance products and plans. A network is typically owned by a payor.

The Network profile is based on the U.S. Core Organization profile, since there is no contradiction between the U.S. Core profile and the Plan-Net requirements.

Note: The NPI and CLIA identifier types, which are Must-Support, are intended for provider organizations only; therefore, they are not expected to be populated for other organization types.

In the Plan-Net implementation guide, individuals and organizations are represented as participants in a Plan-Net Network through the practitionerRole (individuals) and Plan-Net-organizationAffiliation (organizations) resources.

Note: The relationship between InsurancePlans and Networks is many-to-many.

This structure refers to the following:

  • Structures
    • plannet-Organization
    • plannet-Endpoint
  • Extensions
    • location-reference
    • contactpoint-availabletime
    • via-intermediary

Search Details

Since the Plan-Net Network and Organization profiles are both based on the Organization profile, you must distinguish which of these you want to search for if you want to narrow your search. To selectively query only Network profiles, search for type = ntwk. To selectively query only Organization profiles, search for type = fac,bus,prvgrp,payer,atyprv.

Note: Unlike Plan-Net, CARIN for Blue Button® does not have a separate Network resource profile; all Network parameters are handled by the Organization resource in C4BB.

References

Many of the defined elements in a resource are references to other resources. Using these references, the resources combine to build a web of information about healthcare. The Network profile references these resources:

Anticipated Queries

Use Postman to test Opala’s Provider Directory API by querying the API and returning the results. Opala’s Collection is a group of API requests that are already saved in the Postman app and arranged in folders. Within each folder are pre-defined requests that you can run as-is or modify to fit your own needs.

Contact us to request a copy of the Postman collection for the Provider Directory API.

Search for an Organization’s Networks

Retrieve Network Organizations.

GET {{baseurl}}/Organization?type=ntwk

Search for All of an Organization Affiliation’s Networks that Include a Specialty

Retrieve Network Organizations that include the specified specialty.

GET {{baseurl}}/OrganizationAffiliation?network=Organization/[network]&specialty=[code]

More Information about the Plan-Net Network profile