For Payers

Complying with CMS requirements for Provider Directory APIs

The CMS Final Rule on Interoperability and Patient Access requires that health insurers publish a Provider Directory API with information about in-network providers. This information is used by patients to search for in-network providers and evaluate health plan networks. Providers also use this information to assist with referring patients to other in-network providers. Defacto Health has observed that over 73% of payers have published a Provider Directory API since the July 2021 rule enforcement date.

Four steps to integrate with your Provider Directory API

How We Can Help You​

We want to help payers, at no cost, ensure their Provider Directory APIs present data that patients need to search for in-network providers and make the best decisions about health plan enrollment.

We can test your Provider Directory API

We can test your Provider Directory API and provide test results (and issue reproduction steps) to your technical team. We can test and confirm issue resolutions as well. We usually turn these tests around to your team within 1 or 2 business days.

We can issue a letter stating that your API supports CMS Rule requirements

Once successfully integrated, upon request, we can provide a signed letter stating that your Provider Directory API is functional and provides sufficient data to support patient use cases. Your organization will appear on a list of integrated payers that is viewable by regulatory bodies.

Your API will help improve your members’ experience

Through our partners, your data will have a positive impact on millions of patients across the country, as they search for in-network providers, evaluate and select health plans, and as providers refer them to other in-network providers. Your API will help make the healthcare experience more seamless for your members as they leverage your plan information in a variety of digital and in-person contexts.

Contact us for a no-cost evaluation of your API.

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