Sharp Health Plan Provider Directory API

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This asset provides the API specification for the Provider Directory API needed to meet CMS interoperability requirements and is built according to the Da Vinci PDEX Plan Net implementation guide.

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Overview

This asset provides the API specification for the Provider Directory API needed to meet CMS interoperability requirements and is built according to the Da Vinci PDEX Plan Net implementation guide.

The Provider Directory API accesses the Sharp Health Plan’s FHIR server portion of the Provider Directory. Utilizing only read-only RESTful GET API calls (PUT and POST are not currently supported), anyone can access network provider information. Please note the Pharmacy directory data is not currently available in the source system. We will update this page once Pharmacy data is available.

Note: This API conforms to the DaVinci Health Level 7® (HL7) Fast Healthcare Interoperability Resources (FHIR®) 4.0.1 standards, and does not require authorization to access the data on the server, because customer data is not being shared.

This API allows you to help SHP customers by making information about providers easily accessible. By creating a Provider Directory application, you can enable customers and providers to do the following:

  • Use search parameters to filter providers by specialty and/or location.
  • Lookup a provider's office hours and location.
  • Determine whether or not a provider is accepting new patients.
  • Find specialists that are in-network and the hospital they're associated with.
  • Discover what specialties a local hospital provides.

The below section describes the FHIR profiles and RESTful capabilities that the Provider Directory API supports. The RESTful capability statement available in the below URL.

Capability Statement: https://shp-apis.sharphealthplan.com/shpconformance/api/metadata

What is Da Vinci?

Da Vinci is a private sector initiative that addresses the needs of the Value-Based Care Community by leveraging the HL7 FHIR platform. You can find out more details about the Da Vinci project here.

The Center for Medicare and Medicaid Services (CMS) recommends the Da Vinci implementation guide to satisfy the data requirements for the Provider Directory API.

Use case

Provider directories play a critical role in enabling the 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

Resources
Resource Definition Supported Search Parameters Unsupported Search Parameters
Location A Location is the physical place where healthcare services are provided, practitioners are employed, organizations are based, etc.
  • address-postalcode
  • address-state
  • address-city
  • address
  • type
  • identifier
  • name
  • organization
  • status
  • _count
  • _getpagesoffset
  • address-country
  • address-use
  • endpoint
  • partof
  • near
  • operational-status
PractitionerRole PractitionerRole describes the role a practitioner plays at an organization, including the services they provide, the location(s) where they work, and their availability, electronic endpoints, and other relevant information.
  • location
  • organization
  • network
  • service
  • identifier
  • practitioner
  • specialty
  • role
  • _count
  • _getpagesoffset
  • email
  • date
  • endpoint
Practitioner Practitioner is a person who is directly or indirectly involved in the provisioning of healthcare.
  • active
  • address-city
  • address-postalcode
  • address-state
  • address-use
  • communication
  • family
  • gender
  • given
  • identifier
  • name
  • phone
  • telecom
  • _count
  • _getpagesoffset
  • email
  • phonetic
  • address-country
Organization An organization is a formal or informal grouping of people or organizations with a common purpose, such as a company, institution, corporation, community group, or healthcare practice. It also refers to a healthcare provider insurance network. It is an aggregation of organizations and individuals that deliver a set of services.
  • identifier
  • active
  • name
  • type
  • address-city
  • address-postalcode
  • address-state
  • address-country
  • address
  • _count
  • _getpagesoffset
  • endpoint
  • partof
  • phonetic
HealthcareService The HealthCareService resource typically describes services offered by an organization/practitioner at a location
  • active
  • name
  • organization
  • specialty
  • service-category
  • service-type
  • coverage-area
  • location
  • _count
  • _getpagesoffset
  • endpoint
  • identifier
  • characteristic
  • endpoint
InsurancePlan An InsurancePlan is a discrete package of health insurance coverage benefits that are offered under a particular network type
  • coverage-area
  • administered-by
  • name
  • owned-by
  • status
  • type
  • _count
  • _getpagesoffset
  • address
  • address-city
  • address-country
  • address-postalcode
  • address-state
  • address-use
  • endpoint
  • identifier
  • phonetic
Network A Network refers to a healthcare provider insurance network. A healthcare provider insurance network is an aggregation of organizations and individuals that deliver a set of services across a geography through health insurance products/plans. A network is typically owned by a payer.
  • coverage-area
  • active
  • address
  • address-city
  • address-postalcode
  • address-state
  • name
  • _count
  • _getpagesoffset
  • address-use
  • address-country
  • endpoint
  • identifier
  • partof
  • phonetic
  • type
Notes:

All records can be fetched from the DB if there is no search parameter passed into the request. Applied limitation on search results count per page by default 20 and to fetch next page results use the next link url as shown in the example.

resources/Pagination-b05cb881-c6d1-4d4a-af3b-fb761ce33421.png

The default values take precedence if _count and _getpagesoffset are not passed into the Client Request.

_count=20, _getpagesoffset=0


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