Plan-Net PractitionerRole (7.61.1)

The PractionerRole resource profile 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 an organization, there may also be a relationship to a practitioner. Practitioner participation in healthcare provider insurance networks may be direct or through their role at an organization.

Two of the key profile changes to PractitionerRole relative to U.S. Core are:

• Practitioner to 0..1 to allow a role definition without assigning it to a specific practitioner
• Organization to 0..1 to allow an individual practitioner that does not have an organization with an NPI

The PractitionerRole structure is derived from the FHIR R4 PractitionerRole resource. However, this is not the latest version of the resource. If you wish toS view the latest version, you can find the link in the shaded box near the top of the linked page.

The PractitionerRole resource provides the details of roles that the practitioner is approved to perform for which organizations, at which locations the provider is approved to provide healthcare services, and optionally what services the practitioner is approved to perform.

References

Many of the defined elements in a resource are references to other resources. Using these references, the resources combine to build a web of information about healthcare. The Practitioner profile references these resources:

• Plan-Net Location
• Plan-Net OrganizationAffiliation
• Plan-Net Organization
• Plan-Net PractitionerRole

Constraint

ID	Path	Details
practitioner-or-organization-or-healthcareservice-or-location	PractitionerRole	If PlannetPractitionerRole.practitioner is absent, PlannetPractitionerRole.organization, PlannetPractitionerRole.healthcareservice, and PlannetPractitionerRole.location must be present : practitioner.exists() or (organization.exists() or healthcareservice.exists() or location.exists())

Syntax

Currently, you use the following syntax to search for a practitioner role:

https://[base_url]/PractitionerRole/PD-[NPI Number]-role

Anticipated Queries

Use Postman to test Opala's Provider Directory API by querying the API and returning the results. The Opala Collection is a group of API requests that are already saved in the Postman app and arranged in folders. Within each folder are pre-defined requests that you can run as-is or modify to fit your own needs.

See the Setting Up Postman topic in this documentation set for information on how to import the Opala Collection into your local copy of Postman.

You can view Opala's Capability Statement at https://api.opalahealth.io:45000/pdir/premera/v1/fhir/r4/metadata for a description of the Provider Directory API to assist you in making your queries.

Search PractitionerRole

Retrieve all PractitionerRole resources.

GET {{base_url}}/PractitionerRole

Search by Location

Retrieve the PractitionerRoles available at the specified location.

GET {{base_url}}/PractitionerRole?location=Location/[location]

Search Practitioner

Retrieve roles filled by the specified practitioner.

GET {{base_url}}/PractitionerRole?practitioner=Practitioner/[practitioner]

Search Services

Select PractitionerRoles providing the specified service.

GET {{base_url}}/PractitionerRole?service=Service/[service]

Examples

• Joe Smith (Physician - Hartford General Hospital)
• Joe Smith (Physician - Burr Clinic)
• Joe Smith (Admitting Privileges - Hartford General Hospital)

More Information about the plannetPractitionerRole profile

• Plan-Net PractitionerRole Snapshot Table (Must Support) (7.61.1.2)
• Plan-Net PractitionerRole Terminology Bindings (7.61.1.2.1)
• Plan-Net PractitionerRole Detailed Descriptions (7.61.5)
• CodeSystem: Provider Role Codes (7.109.1)
• FHIR Resource References (2.3.0)