Search for a Specific Provider

Identify an individual, organization, or hospital provider and their locations

Provider participation is a key component of making an informed selection for individuals and families shopping for health plans in the ACA or Medicare Advantage markets. As part of this shopping process, users often want to answer the question: "which of the plans available to me are in-network for my doctor(s)?". This workflow can be completed in two integrated steps: identifying the provider and evaluating participation across eligible plans.

Ideon's "Provider Search" endpoint (API docs) can be used to search for healthcare providers with search criteria including geography, search term, provider specialty, and more. This is a required first step when building a "Shop by Doc" experience - presenting quoted plans for an end-user with provider participation. This workflow is summarized in the Shop by Doc section; this page covers the provider search step in detail.

Configuring Search Requests

This section includes recommendations for structuring integrations to optimize for the requirements of your specific use case. The "Provider Search" endpoint supports various request parameters for filtering of responses. Following best practices when using this endpoint improve result accuracy and end-user experience. Deep dives into the following search criteria are included.

• Recommended Search Structure

• Provider Name Search Term

• Filtering by Geographies

• Filtering by Provider Specialty

• Provider Type

• Accepts Insurance

Provider Search Responses

This section details various aspects of the "Provider Search" endpoint responses, how to best present data in front-end interfaces, and how to interpret various search scenarios. The following topics are covered.

• Result Schema and Data Dictionary

• Provider Address Filtering

• Ranking and Sorting of Results

Shop by Doc - Quote Individuals with Provider Participation

This section details how to pass selected providers with their npi and address_id identifiers to evaluate provider participation in quoted plans in the IFP Medical and Medicare Advantage quoting workflows.