{
  "name": "payer-provider-directory-mcp",
  "title": "HealthMesh · Payer Provider Directory MCP",
  "version": "0.1.2",
  "description": "Live in-network lookups in public health-plan provider directories published under the CMS Interoperability rule (CMS-9115-F, HL7 Da Vinci PDex Plan-Net FHIR R4): find a practitioner by NPI or name in Cigna Healthcare's and Humana's directories and see their networks/plans, specialties, practice locations and whether they accept new patients. Directory accuracy varies by payer; absence is not proof of out-of-network.",
  "healthmesh_domain": "Provider & Network",
  "datasets": [
    "PROV-08"
  ],
  "mcp_endpoint": "https://payer-provider-directory.healthmesh.ai/mcp",
  "transport": "Streamable HTTP (stateless, JSON responses)",
  "authorization": "none",
  "auth_mode": "off",
  "docs": "https://github.com/HendrikK/healthmesh/tree/main/servers/payer-provider-directory-mcp#readme",
  "contact": "hendrik.kleine@gmail.com",
  "data_source": {
    "name": "Public payer Provider Directory APIs (CMS Interoperability rule CMS-9115-F, HL7 Da Vinci PDex Plan-Net FHIR R4): Cigna Healthcare, Humana; NPPES NPI Registry API",
    "url": "https://www.cms.gov/priorities/key-initiatives/burden-reduction/interoperability/policies-regulations/cms-interoperability-patient-access-final-rule-cms-9115-f",
    "license": "Public payer directory data published under CMS-9115-F (no authentication); NPPES is a U.S. Government work",
    "refresh": "live (1 h edge cache); payers update their directories continuously"
  },
  "tools": [
    {
      "name": "pdir_list_payer_endpoints",
      "title": "List the payer provider-directory APIs this server can search",
      "description": "Lists the public payer Provider Directory FHIR (Plan-Net) endpoints this server searches live, with markets, search capabilities and a live health check (CapabilityStatement fetch). Use first to see which payers are covered; currently Cigna Healthcare and Humana."
    },
    {
      "name": "pdir_search_practitioners",
      "title": "Search payer directories for a practitioner (by NPI or name)",
      "description": "Searches the live Cigna and/or Humana provider directories for an individual practitioner by NPI or by family (+ given) name, and returns per payer: specialties (NUCC taxonomy), networks/plans, practice locations and new-patient status. Optional filters on location (state, city, 5-digit ZIP), specialty code and accepting new patients are applied to the practitioner's directory roles. Payer directories do not support area-wide searches without a name or NPI. For a yes/no check of one NPI in one payer/plan use pdir_check_in_network."
    },
    {
      "name": "pdir_check_in_network",
      "title": "Check whether an NPI is listed in a payer's (or plan's) directory",
      "description": "Checks whether an individual practitioner's NPI appears in Cigna's or Humana's live provider directory, optionally in a specific network/plan (case-insensitive contains match on the network name, e.g. 'Gold Plus HMO', 'Medicare PPO', 'Connect'), and returns the matching networks, locations, specialties and new-patient status. listed=false is not proof of out-of-network."
    },
    {
      "name": "pdir_describe_dataset",
      "title": "Describe sources, coverage and caveats",
      "description": "Explains where the data comes from (public CMS-9115-F payer Provider Directory APIs, HL7 Plan-Net), which payers are covered, how NPI and name searches work per payer, field meanings and accuracy caveats."
    }
  ]
}