Provider System Registration

As a prerequisite for using the Provider Access API, a provider system must be fully configured and registered against Payer system. This workflow ensures the system can:

• Authenticate and obtain required claims (e.g., NPI, TIN, Organization ID).
• Associate with FHIR resources — specifically, Organization and Group — to link the system to its attributed members.
• Comply with payer security and access requirements.

The registration process includes:

• Registering the provider system with the Payer's Identity Provider (IdP) with appropriate permission. This is based off of Payer's existing security infrastructure.
• Creating Organization resources in the Payer's FHIR repository.
• Creating Group resources for attributed members.

FHIR Resource Requirements

Organization Resource

Represents the provider system using the HRex Organization profile.

Required fields:

• id
• name
• identifier
  • Business Identifiers (BIDs): NPI, TIN
  • Authentication Identifier: Client ID (used for IdP registration)
    • identifier.system = https://smiledigitalhealth.com/credentialmap/oidc/client
• Tag the resource to indicate it belongs to the Exchange Directory:
  • meta.tag.system = https://smiledigitalhealth.com/payer-exchange-directory
  • meta.tag.code = Exchange Directory

Example:

{
  "resourceType": "Organization",
  "meta": {
    "tag": [
      {
        "system": "https://smiledigitalhealth.com/payer-exchange-directory",
        "code": "Exchange Directory"
      }
    ]
  },
  "id": "provider-system-001",
  "identifier": [
    {
      "system": "http://hl7.org/fhir/sid/us-npi",
      "value": "1234567890"
    },
    {
      "system": "https://smiledigitalhealth.com/credentialmap/oidc/client",
      "value": "provider-client-001"
    }
  ],
  "name": "Example Provider System"
}

Group Resource

Defines attributed members associated with the provider system. This resource is based on the PDex Provider Group profile.

• Each Group links members (patients) to a provider system.
• The Group resource references the Business Identifiers (BIDs) from the Organization to associate members.
• Member references point to Patient resources in the FHIR repository.

Example:

{
  "resourceType": "Group",
  "id": "group-001",
  "meta": {
    "profile": [
      "http://hl7.org/fhir/us/davinci-pdex/StructureDefinition/pdex-provider-group"
    ]
  },
  "type": "person",
  "actual": true,
  "member": [
    {"entity": {"reference": "Patient/patient-001"}},
    {"entity": {"reference": "Patient/patient-002"}}
  ]
}