National Directory - Capability Statement

This Section describes the expected capabilities of the NatlDir Server actor which is responsible for providing responses to the queries submitted by the NatlDir Requestors. The complete list of FHIR profiles, RESTful operations, and search parameters supported by NatlDir Servers are defined. Systems implementing this capability statement should meet the CMS FInal Rule requirement for provider directory access. NatlDir Clients can use the required capabilities to access necessary data based on their local use cases and other contextual requirements.

Select Endpoints managed by the specified organization

Select services available in a region described by the specified location

Select HealthcareServices with the specified endpoint

Select HealthcareServices available at the specified location

Select HealthcareServices with the specified name

Select HealthcareServices provided by the specified organization

Select HealthcareServices providing the specified category of services

Select HealthcareServices of the specified type

Select services associated with the specified specialty

Select products that are administered by the specified organization

Select products that are offered in the specified location

Select products with the specified identifier

Select products with the specified name

Select products that are owned by the specified organization

Select plans of the specified type

Select insurance plans of the specified type

Select Locations with the specified address.city

Select Locations with the specified address

Select Locations with the specified address.state

Select Locations with the specified address

Select Locations with the specified endpoint

Select Locations managed by the specified organization

Select Locations that are part of the specified location

Select Locations of the specified type

Select organizations with the specified address (matches any of the string elements of an address)

Select health insurance provider networks available in a region described by the specified location

Select Organizations with the specified endpoint

Select Organizations with the specified name

Select Organizations that are part of the specified organization

Select Organizations of the specified type

Select OrganizationAffiliations with the specified endpoint

Select OrganizationAffiliations available at the specified location

Select roles where the organization is a member of the specified health insurance provider network

Select roles filled by the specified organization

Select roles offered by the specified organization

Select OrganizationAffiliations with the specified role

Select OrganizationAffiliations providing the specified service

Select OrganizationAffiliations associated with the specified specialty

Select Practitioners with the specified family name

Select Practitioners with the specified given name

Select Practitioners with the specified name (matches against any of the elements in the HumanName data type)

Select PractitionerRoles with the specified endpoint

Select PractitionerRoles available at the specified location

Select roles where the practitioner is a member of the specified health insurance provider network

Select PractitionerRoles available at the specified organization

Select PractitionerRoles available in the specified period

Select roles filled by the specified practitioner

Select PractitionerRoles with the specified role

Select PractitionerRoles providing the specified service

Select PractitionerRoles associated with the specified specialty

Select CareTeams of the specified type

Select CareTeams with the specified endpoint

Select CareTeams with an identifier issued by the specified organization

Select CareTeams with the specified identifier

Select care teams operating at the specified location

Select care teams with the specified name

Select care teams managed by the specified organization

Select care teams that include the specified member

Select care teams providing the specified service

Select CareTeams with the specified status

Select CareTeams with contact information available through the specified intermediary

Select Endpoints that support the specified protocol/profile/standard

Select Endpoints with an identifier issued by the specified organization

Select Endpoints with the specified identifier

Select endpoints that support the specified media type

Select Endpoints that support the specified type of content

Select Endpoints with the specified status

Select endpoints that support the specified standard

Select endpoints that support the type of services indicated by the specified code

Select Endpoints with contact information available through the specified intermediary

Select HealthcareServices with the specified characteristic

Select services with the specified eligibility requirements

Select HealthcareServices with an identifier issued by the specified organization

Select HealthcareServices with the specified identifier

Select HealthcareServices that are part of the specified network and are/are not accepting new patients

Select HealthcareServices that are/are not accepting new patients

Select HealthcareServices with contact information available through the specified intermediary

Select health insurance products offering covered benefits of the specified type

Select health insurance products with covered benefits limited in the specified manner

Select products offering covered benefits through the specified health insurance provider network

Select products offering the specified type of coverage

Select health insurance products/plans with the specified endpoint

Select plans with costs for the specified group size

Select plans with the specified type of cost

Select plans which include the specified cost

Select products associated with the specified health insurance provider network

Select plans that are available in the specified location

Select plans with the specified identifier

Select plans associated with the specified health insurance provider network

Select plans which include costs for the specified type of benefit

Select plans which include costs for the specified category of coverage

Select plans which include the specified type of cost

Select plans which include the specified cost

Select health insurance products/plans with the specified status

Select locations that offer the specified accessibility options

Select locations that contain the specified co-ordinates

Select Locations with an identifier issued by the specified organization

Select Locations with the specified identifier

Select locations that are part of the specified network and are/are not accepting new patients

Select locations that are/are not accepting new patients

Select Locations with the specified status

Select Locations with contact information available through the specified intermediary

Select organizations with an address in the specified city

Select organizations with an address in the specified country

Select organizations with an address with the specified postal code

Select organizations with an address in the specified state

Select Organizations with an identifier issued by the specified organization

Select Organizations with the specified identifier

Select Organizations with a type of qualification matching the specified code

Select Organizations with a qualification issued by the specified organization

Select Organizations with a qualification status matching the specified code

Select Organizations with a qualification that is valid at the location indicated by the specified code

Select Organizations with a qualification that is valid at the specified location

Select Organizations with contact information available through the specified intermediary

Select OrganizationAffiliations with an identifier issued by the specified organization

Select OrganizationAffiliations with the specified identifier

Select OrganizationAffiliations with contact information available through the specified intermediary

Select organizations with an address in the specified city

Select practitioners with an address with the specified postal code

Select organizations with an address in the specified state

Select Practitioners with the specified endpoint

Select Practitioners with an identifier issued by the specified organization

Select Practitioners with the specified identifier

Select Practitioners with the specified name (A portion of name using some kind of phonetic matching algorithm)

Select Practitioners with the specified name (A portion of name using some kind of phonetic matching algorithm)

Select Practitioners with a type of qualification matching the specified code

Select Practitioners with a qualification issued by the specified organization

Select Practitioners that have a qualification relevant to the date provided

Select Practitioners with a qualification status matching the specified code

Select Practitioners with a qualification that is valid at the location indicated by the specified code

Select Practitioners with a qualification that is valid at the specified location

Select Practitioners with contact information available through the specified intermediary

Select PractitionerRoles with an identifier issued by the specified organization

Select PractitionerRoles with the specified identifier

Select PractitionerRoles that are part of the specified network and are/are not accepting new patients

Select PractitionerRoles that are/are not accepting new patients

Select PractitionerRoles with a type of qualification matching the specified code

Select PractitionerRoles with a qualification issued by the specified organization

Select PractitionerRoles with a qualification status matching the specified code

Select PractitionerRoles with a qualification that is valid at the location indicated by the specified code

Select PractitionerRoles with a qualification that is valid at the specified location

Select PractitionerRoles with contact information available through the specified intermediary

Select validation information for data that was attested to using the specified method

Select validation information for data that was attested to on behalf of the specified source

Select validation information for data that was attested to by the specified source

Select validation information for data that was validated against a primary source on the specified date

Select validation information for data that was validated against the specified type of primary source organization

Select validation information for data that was validated against the specified primary source

Select validation information with a validation status that occurred at the specified date/time

Select validation information for the specified resource

Select validation information with the specified status

Select validation information for data that was validated by the specified organization

Defines the basic constraints and extensions on the CareTeam resource for use in a Validated Healthcare Directory

The technical details of an endpoint that can be used for electronic services, such as a portal or FHIR REST services, messaging or operations, or DIRECT messaging.

The HealthCareService resource typically describes services offered by an organization/practitioner at a location. The resource may be used to encompass a variety of services covering the entire healthcare spectrum, including promotion, prevention, diagnostics, pharmacy, hospital and ambulatory care, home care, long-term care, and other health-related and community services.

An InsurancePlan is a discrete package of health insurance coverage benefits that are offered under a particular network type. A given payer’s products typically differ by network type and/or covered benefits. A plan pairs a product’s covered benefits with the particular cost sharing structure offered to a consumer. A given product may comprise multiple plans (i.e. each plan offers different cost sharing requirements for the same set of covered benefits).

A Location is the physical place where healthcare services are provided, practitioners are employed, organizations are based, etc. Locations can range in scope from a room in a building to a geographic region/area.

A Network refers to a healthcare provider insurance network. A healthcare provider insurance network is an aggregation of organizations and individuals that deliver a set of services across a geography through health insurance products/plans. A network is typically owned by a payer.

An organization is a formal or informal grouping of people or organizations with a common purpose, such as a company, institution, corporation, community group, or healthcare practice. Guidance: When the contact is a department name, rather than a human (e.g., patient help line), include a blank family and given name, and provide the department name in contact.name.text

The OrganizationAffiliation resource describes relationships between two or more organizations, including the services one organization provides another, the location(s) where they provide services, the availability of those services, electronic endpoints, and other relevant information.

Practitioner is a person who is directly or indirectly involved in the provisioning of healthcare.

PractionerRole describes details about a provider, which can be a practitioner or an organization. When the provider is a practitioner, there may be a relationship to an organization. A provider renders services to patients at a location. When the provider is a practitioner, there may also be a relationship to an organization. Practitioner participation in healthcare provider insurance networks may be direct or through their role at an organization.

Restriction on use/release of exchanged information

Describes validation requirements, source(s), status and dates for one or more elements

Codes for use in defining access levels for sharing subsets of constrained content (as an example).

NPPI Healthcare Provider Taxonomy

Value Set for Organization Affiliation Roles

Codes to identify if the practice is accepting new patients

General categories of accommodations available.

Codes for use in defining access levels for sharing subsets of constrained content (as an example)

This value set includes the four Consent scope codes.

Categories of healthcare service delivery methods.

Extension codes for http://terminology.hl7.org/CodeSystem/endpoint-connection-type

Endpoint Payload Types are constrained to NA (Not Applicable) as part of this IG

Endpoint Type Code System

Broad categories of healthcare services being performed or delivered

IG Type Code System

Categories of cost-sharing used by plans

A distinct package of health insurance coverage benefits that are offered using a particular product network type.

Codes for documenting spoken language proficiency based on the Interagency Language Roundtable scale.

Categories of organizations based on criteria in provider directories.

Codes For Organization Affiliation Role

A capability that an individual, group, or organization is acknowledged to have in a payer network.

The state indicating if a qualification is currently valid.

Trust Framework Type

Categories of virtual service delivery modalities.

TestScript - Attestation of new clinic information.

TestScript - Restricted access to women’s shelters.

TestScript - Distribute App (DApp) access to a centralized directory.

TestScript - Dynamic Client Registration

TestScript - Verification of provider qualifications

TestScript - PUSH messaging via Subscriptions from National Directory to Federated instances.

Scenario - Subscriptions between National and Federated directories

Scenario - Restricted Womens’ Shelter Access

Endpoint for Acme of CT Portal

Burr Clinic’s Care Team

Scenario - Verify Practitioner Credentials

Scenario - Federated Endpoint Query

Scenario - New Facility Attestation

Patient that gives consent

Practitioner - Joe Smith

Patient that gives consent

Scenario - Dynamic Client Registration

Restriction (Consent) on accessing Women’s Shelter locations to certified Social Workers only

Device - National Directory

Device - Federated Directory

HealthcareService - Pharmacy chain mail service

HealthcareService - Emergency Medical Services

Hans Solo Services

HealthcareService - Pharmacy chain compounding pharmacy service

HealthcareService - Family Medicine Solo Practice

HealthcareService - Virtual telehealth visit with professional counselor

HealthcareService - Pharmacy chain retail service

HealthcareService - Family Medicine

HealthcareService - Hartford Orthopedics

HealthcareService - Medical Oncology

Acme of Conneticut - Gold Plan

Acme of Conneticut - Silver Plan

Acme of Conneticut - Bronze Plan

State of Conneticut - Geographical Area

456 Main Street, Anytown, CT, 00014

123 Main Street, Anytown, CT, 00014

123 Main Street, Anytown, CT, 00014

Women’s Shelter - 345 Main Street, Nowheresville, CT, 00014

456 Main Street, Somewhere, CT, 00014

456 Main Street, Anytown, CT 00014

444 Main Street, Rainbow, CT, 00014

ACME Preferred

ACME of Conneticut

ACME Premium

Big Box, LLC

Connecticut Health Information Exchange (CHIE)

Burr Clinic

Hamilton Clinic

Hartford General Hospital

St. Jame’s Infirmary

Hartford Orthopedics

GoodRx Pharmacy

ACME Pharmacy

Fast Scan Radiology

Health and Human Services

The Joint Commission on the Accreditation of Healthcare Organizations

Burr Clinic Outpatient Network

GoodRx Retail Pharmacy Network

GoodRx Compounding Pharmacy Network

GoodRx Mail Order Network

Connecticut HIE Network

Hamilton Clinic Outpatient Network

Hartford Orthopedic Provider Network

CT Department of Public Health

US Post Office

Centers for Medicare and Medicaid Services

Practitioner - Han Solo

Practitioner - Susie Song, Social Worker

Practitioner - Allison Camron

Role - Anonymous users not registered with the system

Role - Conselor or therapist

Role - Part time physician, part time smuggler

Role - Self defined role 3

Role - Self defined role 2

Role - Self defined role 1

Subscription updates arrive via websockets.

Subscription updates arrive via POST, PUSH, PATCH operations to HTTP endpoints.