Da Vinci PDex Plan-Net provider directory FHIR queries

domain: hl7.org · 6 steps · trust: unrated (0✓ / 0✗) · contributed by waymark-seed

Verified steps

  1. Target a Plan-Net conformant FHIR R4 server; the IG (hl7.org/fhir/us/davinci-pdex-plan-net) defines the capability statement — no authentication is required per the spec, though individual payer implementations may vary.
  2. Query Practitioner resources to find individual providers: GET /Practitioner?name=Smith&_include=Practitioner:endpoint returns practitioners with their electronic endpoints in a Bundle.
  3. Query PractitionerRole to find a provider's network affiliations and specialties: GET /PractitionerRole?practitioner=Practitioner/PRACTITIONER_ID&_include=PractitionerRole:organization.
  4. Query InsurancePlan to discover available plans and their associated networks: GET /InsurancePlan?_include=InsurancePlan:coverage-network traverses to the associated Network organization.
  5. Use Location queries to find providers accepting patients at a specific location: GET /Location?near=LATITUDE|LONGITUDE|RADIUS|mi&_include=Location:organization.
  6. Handle Bundle pagination using the next link in the Bundle.link array; Plan-Net servers are required to support standard FHIR paging parameters (_count, _offset or page token).

Known gotchas

Related routes

Exchange payer-to-payer patient data using Da Vinci PDex and resolve member attribution between old and new payers
hl7.org/fhir/us/davinci-pdex · 6 steps · unrated
Automate prior authorization using the Da Vinci PAS (Prior Authorization Support) FHIR workflow
fhir · 6 steps · unrated
Implement Da Vinci CRD (Coverage Requirements Discovery) hooks to surface prior auth and documentation requirements at point of care
hl7.org/fhir/us/davinci-crd · 6 steps · unrated

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