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Provider Directory API:

General Information

Find all the information you need to meet compliance for the Provider Directory CMS Interoperability Final Rule

Improving Interoperability

Modern day healthcare is governed by data. However, data is kept siloed within separate health systems, making it difficult to integrate patient information and improve care. 

The Centers for Medicare and Medicaid Services (CMS) is addressing this problem through the Interoperability and Patient Access Final Rule. Part of this rule requires health plans (payers) to implement a Provider Directory API by July 1st, 2021, using FHIR-based APIs. The resulting Provider Directory, that outlines the in-network providers, is a public-facing digital endpoint accessible through the payers’ website. This promotes public discovery, accessibility and workflow efficiency. 

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The Overall Goal

When data is added or changed, the Provider Directory API must be updated within 30 days and be made available to current and prospective health plan users. This ensures transparency, consistency and continuity. This mandate needs to be implemented by July 1st, 2021. To help with this process, read the open-source implementation guide, Da Vinci Payer Data Exchange (PDEX) Plan Network IG.

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