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Introduction

Under the CMS Interoperability and Patient Access final rule, Medicare Advantage, Medicare Part D, Medicaid Managed Care, and other similar federal programs are required to make provider directory information available via the Provider Directory API. This API must be accessible via a public-facing digital endpoint on the payer’s website.

Note that we partner with a broad network of doctors, dentists, pharmacies, and other healthcare facilities. You can always use our Doctor and Pharmacy Directory makes it easy to find the care patient needs.

List of APIs CCA Provides

Practitioner

Practitioner covers all individuals who are engaged in the healthcare process and healthcare-related services as part of their formal responsibilities. This Resource is used for attribution of activities and responsibilities to these individuals.


Location

A Location includes both incidental locations (a place which is used for healthcare without prior designation or authorization) and dedicated, formally appointed locations. Locations may be private, public, mobile or fixed and scale from small freezers to full hospital buildings or parking garages.


Insurance Plan

A product is a discrete package of health insurance coverage benefits that are offered under a particular network type. A given payer’s products typically differ by network type and/or coverage benefits. A plan pairs the health insurance coverage benefits under a product with the particular cost sharing structure offered to a consumer. A given product may comprise multiple plans.


Practitioner Role

Practitioner Role covers the recording of the location and types of services that Practitioners can provide for an organization. The role, specialty, Location telecom and Healthcare Service properties can be repeated if required in other instances of the Practitioner Role.

Healthcare Service

The Healthcare Service resource is used to describe a single healthcare service or category of services that are provided by an organization at a location. The location of the services could be virtual, as with telemedicine services.


Organization Affiliation

A relationship between 2 organizations over a period of time, where the entities are separate business entities. The relationship can optionally include details of locations/services from the participating organization. The Organization Affiliation enables defining non-hierarchical relationships between organizations.


Organization

This resource may be used in a shared registry of contact and other information for various organizations, or it can be used merely as a support for other resources that need to reference organizations, perhaps as a documentmessage or as a contained resource. If using a registry approach, it’s entirely possible for multiple registries to exist, each dealing with different types or levels of organization.


Getting Started

CCA’s Interoperability API Developer Portal

The CCA Interoperability API Developer Portal provides third-party app developers with access to documentation.

Commonwealth Care Alliance Provider Directory FHIR server does not maintain any records that can be associated with a consumer. Therefore, the Provider Directory API does not require third-party applications to send consumer identifying information and does not require authentication.

Our API Functionality

The Provider Directory API accesses the Commonwealth Care Alliance FHIR server portion of the Provider and Pharmacy Directories. Utilizing only read-only RESTful GET API calls (PUT and POST are not currently supported), you can create an application to access information about providers and pharmacies.

This section describes the FHIR profiles, resources and RESTful capabilities that the Provider Directory API supports. A profile is a set of rules which allows a resource to be constrained, or to include extensions, so the resource can add additional attributes. The RESTful capabilities are discussed in further detail below.

Support

We’re here to help. If you are having an issue related to one of the Provider Directory APIs, please email: [email protected]

Please note: do not send member’s personal health information through email. Member specific claims issues or authentication issues (e.g., forgot username or password) will not be resolved through the developer support mailbox.


Announcements

API Release Notes:

Production Environment Notes

Date: July 1st, 2021

Release information: Initial Release of the Provider Directory APIs.

This includes:

Key Third Party Resources

Provider Directory API: Da Vinci Payer Data Exchange Plan Net Directory

Best practices for Payers and App Developers

**Note: the dates listed are subject to change.

Patient access APIs are out of scope for this release. Check back later for updates on the release of these APIs.