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Payer Provider Directory API

The Netsmart CareConnect Provider Directory API provides access to payer network information including healthcare providers, organizations, locations, services, and insurance plans. This publicly accessible API enables applications to discover and access provider network data without authentication.

API Specification​

  • Version: 2.0
  • Protocol: HTTPS only
  • Data Format: FHIR R4 (JSON/XML)
  • Authentication: None required (public API)
  • Rate Limiting: Standard rate limits apply
  • Base URL: https://fhir.netsmartcloud.com/payer/provider-directory/v2/{tenant-id}

Base URL Structure​

https://fhir.netsmartcloud.com/payer/provider-directory/v2/{tenant-id}
  • Version: v2 (FHIR R4)
  • Tenant ID: Unique identifier for your CareConnect payer tenant
  • Public Access: No authentication required

Authentication​

No Authentication Required - Provider Directory APIs are publicly accessible and do not require API keys, tokens, or other authentication mechanisms. This allows for easy integration and discovery of provider network information.

Rate Limiting​

Standard rate limits apply to prevent abuse and ensure service availability. Rate limit information is returned in response headers when limits are approached.

Use Cases​

Common scenarios for using the Provider Directory API:

  • Provider Network Discovery: Find healthcare providers within a specific insurance network
  • Geographic Provider Search: Locate providers by specialty within a geographic area
  • Insurance Plan Verification: Verify which providers accept specific insurance plans
  • Healthcare Service Lookup: Find available services at specific locations
  • Provider Contact Information: Retrieve current contact details and addresses for providers
  • Network Affiliation Verification: Confirm provider relationships with organizations and networks

Quick Start​

New to the Provider Directory API? Start here:

  1. Getting Started Guide - Overview and first steps
  2. Postman Tutorial - Interactive testing guide
  3. Service Base URLs - Discover available endpoints using the Service Base URL documentation

Data Model Overview​

Provider Directory resources are interconnected to represent the healthcare ecosystem:

Organization (Payer/Provider Org)
├── InsurancePlan (Insurance products)
├── Location (Physical locations)
│   └── HealthcareService (Services offered)
├── OrganizationAffiliation (Network relationships)
└── PractitionerRole (Provider roles)
    ├── Practitioner (Individual providers)
    └── Endpoint (Technical access points)

Quick Start Examples​

Check API Capabilities​

curl https://fhir.netsmartcloud.com/payer/provider-directory/v2/{tenant-id}/metadata

Find Organizations​

curl "https://fhir.netsmartcloud.com/payer/provider-directory/v2/{tenant-id}/Organization?_count=5"

Search Practitioners​

curl "https://fhir.netsmartcloud.com/payer/provider-directory/v2/{tenant-id}/Practitioner?family=Smith"

Resources​

ResourceReadSearchDescription
CapabilityStatement✅Server capabilities and supported operations
Endpoint✅✅Technical endpoints for electronic services
HealthcareService✅✅Healthcare services available at locations
InsurancePlan✅✅Health insurance products and plans
Location✅✅Physical places where services are provided
Organization✅✅Healthcare organizations and payers
OrganizationAffiliation✅✅Relationships between organizations
Practitioner✅✅Individual healthcare providers
PractitionerRole✅✅Roles practitioners perform for organizations

HTTP Status Codes​

CodeDescriptionWhen It Occurs
200OKSuccessful request
400Bad RequestInvalid parameters or malformed request
403ForbiddenInvalid URL path or unsupported endpoint
404Not FoundResource not found or unsupported resource type
429Too Many RequestsRate limit exceeded
500Internal Server ErrorServer error

Response Format​

All responses follow FHIR R4 standards:

  • Single Resource: Returns the requested resource directly
  • Search Results: Returns a Bundle resource containing matching entries
  • Errors: Returns an OperationOutcome resource with issue details

Performance Guidelines​

  • Pagination: Use _count parameter to limit results (default: 100, max: 500)
  • Filtering: Apply specific search parameters to reduce result sets
  • Caching: Provider directory data changes infrequently; consider caching strategies
  • Geographic Searches: Use address parameters for location-based queries
  • Rate Limiting: Implement exponential backoff for 429 responses

Common Search Patterns​

Find Providers by Specialty and Location​

POST /PractitionerRole/_search
Content-Type: application/x-www-form-urlencoded

specialty=207R00000X&location.address-state=CA&_include=PractitionerRole:practitioner

Search Organizations by Type​

GET /Organization?type=prov&address-city=Sacramento&_count=20

Find Services at a Location​

GET /HealthcareService?location=Location/123&service-category=394802001