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Modeling your Provider Directory

Provider Directories are critical databases housing essential details about healthcare providers, from individual practitioners to entire organizations. Accurate and standardized modeling of these directories, ensures a better patient experience via improved coordination coordination of care and operational efficiency.

This section provide a series of guides on how to properly model your organization's provider directory. It focuses on a few key challenges:

  1. How to model the organizational structure of your provider group: How to represent the clinical divisions and care teams in your clinical organization, including how to represent providers who participate in multiple teams.
  2. How to model provider participation insurance networks: How to model insurance plans and the in-network/out-of-network status of providers.
  3. How to model provider qualifications, certifications, and licenses: How to represent state licensure and specialty certifications for each provider to ensure proper staffing across geography and clinical.

These guides are based on, and compatible with, the Da Vinci PDEX Payer Network guide. The Da Vinci Project is a private sector initiative comprised of industry leaders, including Blue Cross Blue Shield, Cigna, and Optum, etc. working together to accelerate the adoption of FHIR as the standard to support and integrate value-based care (VBC) data exchange.

Key Resources

CareTeamA definition of a group of providers assembled for a specific Patient.
PractitionerA resource that defines the profile of each provider (i.e., physician, nurse, administrator, etc.).

Key Code Systems

Code SystemDescription
SNOMEDUsed to annotate the roles of Practitioner resources. Below is a selection of common SNOMED role codes.
Primary Care Physician446050000
Registered Nurse224535009
Social Worker106328005
Physical Therapist36682004
Occupational Therapist80546007
Recreational Therapist308191009
Center Manager159441000
Home Care Coordinator768730001
Personal Care Attendant768836001