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Provider Directory API

Everything you need to know about the Provider Directory API including its purpose, who it affects, and when it goes into effect.

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Brief

What Is The Provider Directory API?

FHIR® API conformant with the relevant technical requirements outlined in 45 CFR §170.215 that is accessible via a publicfacing digital endpoint and provides a complete and accurate directory of contracted providers, and, if applicable, pharmacies, updated no later than thirty (30) calendar after such data is received or updates to such information.

Contracted Provider Data

Names, addresses, phone numbers, and specialties.

Names, addresses, phone numbers, number of pharmacies in the network, and mix (specifically the type of pharmacy).

Who does this impact?

  • Medicare Advantage (MA)
  • Medicaid
  • Children’s Health Insurance Program (CHIP)
  • Qualified Health Plan (QHP) issuers on the Federally-facilitated Exchanges (FFEs)

When does it take effect?

  • July 1, 2022 for clinical, claims, and encounter data
  • January 1, 2026 for prior authorization data

What Should You Do Next?

Connect with 1upHealth to learn more about the Provider Directory API and how we can help you prepare for when it goes into effect.

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