Plan and Network Identifiers

Find plan or network IDs to search for in-network providers

In order to search for in-network providers, the correct network or plan must be identified to evaluate provider participation against. Supported workflows for this process are dependent on the market. For ACA Medical (Individual/Family and Small Group) and Medicare Advantage, plans are associated with their provider networks, meaning plan and network IDs can be used interchangeably.

The sections on this page detail each workflow to identify plan or network IDs to reference when searching for in-network healthcare providers.

Network Search Endpoint

The primary method for network identification is through the "Network Search" endpoint (API docs). The technical API documentation details available search parameters for networks; see below for some tips for identifying networks.

• A network can be used for multiple product lines and markets, as defined by its metadata in the lines_of_coverage (medical, medicare_advantage, or medicaid) and markets (individual, small_group, or large_group) fields.

• A network's state metadata, as defined by the state_codes array, incorporates the states that a network is mapped to plans in and/or the states that a network meets basic provider availability criteria in.

• To search by carrier, a carrier_id, the unique identifier for the carrier brand across Ideon's Quote and Select datasets, must first be identified. The "Carrier Search" endpoint (API docs) can be used to identify carriers by name, line of coverage, and market.

• In general, we recommend using the "Network Search" endpoint to support users in identifying the networks for Large Group Medical and Medicaid networks. When using network search for this application, using the line_of_coverage, market, carrier_id, and search_term parameters typically balances filtering results to a manageable amount for network selection without being overly strict on the intial filter. However, this is still somewhat dependent on the specificity of the search string. If the desired network isn't found in the results, we recommend removing the search_term parameter.

Plan Inventory for ACA Medical and Medicare Advantage

For ACA Medical (Individual/Family and Small Group) and Medicare Advantage markets, plans are mapped in Ideon's datasets to their provider-networks. The network associated to each plan can be found in plan benefit datasets. Additionally, unique plan identifiers in these markets can be passed directly to the "Provider Search" endpoint (API docs) in place of the identifiers for their mapped networks.

The "Plans in Bulk" endpoint (API docs) can be used to pull available plans and their associated networks. This will return available plans in their respective markets, their unique plan identifiers, and the mapped network's identifier. Either of these two identifiers can be used to search for in-network providers, as detailed in the Configuring Search Requests - Plan or Network Identifiers section.

For most use cases, we recommend caching this mapping of plan to network identifiers on the same cadence as benefits, as outlined in the sections linked above. This is because while the "Provider Search" endpoint accepts plan IDs as a request parameter, it returns the unique set of network IDs that are mapped to the plans requested. These network IDs then need to be linked back to the plans, if that is what is being presented to end users.

Custom Network Mapping for Large Group Medical

In the Large Group Medical market, plan identifiers and catalogues are non-standard and cannot be generically mapped to networks. Typically, employers offering large group plans will have plan documents - SBCs, SOBs, or EOCs, for example - that provide information on the plan and indicators to what its network might be. As a separate service, Ideon can process these large group plan documents to identify the network and its internal identifier. For more information, please contact your Customer Success Manager.