Answers and evidence
Every check answers one question: does the plan's network directory list this provider? The answer is listed with evidence, or not_found. We never turn a missing listing into a "no".
The answer values
| ANSWER | IN_NETWORK | MEANING |
|---|---|---|
listed | true | The network directory of this plan lists the provider. evidence holds each listing. |
not_found | null | No listing found in current directory data for this provider and plan. It is not a statement that the provider is out of network. |
no_provider_network | null | The plan id is a prescription drug plan (it starts with S). Drug plans have no provider network. |
in_network: false is kept for an explicit exclusion that an insurer publishes. v1 does not return it today. Handle it anyway: treat false as "the plan says this provider is not in its network".
How to show it
evidence[].source.as_of.data.explanation is one plain sentence for the answer. You can show it as it is. notes holds short sentences to show next to the answer, for example that directories change and that users should confirm before care.
The evidence block
data.evidence[] holds one entry for each listing we found, newest plan year first. It is empty when the answer is not_found. Each entry carries its own source: the source type and the date we read it.
| FIELD | DESCRIPTION |
|---|---|
plan_id / plan_year | The plan and the plan year of this listing. |
network_tier | Marketplace plans: the tier the directory names, for example PARTICIPATING or PREFERRED. |
accepting_new_patients | Medicare Advantage plans: whether the directory says the provider accepts new patients. |
provider_kind | Medicare Advantage plans: the kind of provider listed, for example practitioner. |
source.type | insurer_directory for marketplace plans, plan_directory for Medicare Advantage plans. |
source.as_of | The date we read that directory. |
A Medicare Advantage answer carries accepting_new_patients and provider_kind instead of a tier:
{ "data": { "npi": "1184617268", "plan_id": "H2526-001-000", "input_plan_id": "H2526-001-000", "market": "ma", "plan_years_listed": [ 2027 ], "in_network": true, "answer": "listed", "explanation": "The plan's network directory lists this provider for this plan.", "evidence": [ { "plan_id": "H2526-001-000", "plan_year": 2027, "accepting_new_patients": true, "provider_kind": "practitioner", "source": { "type": "plan_directory", "as_of": "2026-10-29" } } ], "plan_year": 2027, "plan": { "plan_name": "DEVOTED CHOICE 001 OH (PPO)", "organization": "Devoted Health", "plan_type": "PPO", "service_area_states": [ "OH" ] }, "source": { "type": "plan_directory", "as_of": "2026-10-29" }, "as_of": "2026-10-29" }}
A not_found answer
A not_found answer still returns the plan details we hold, so you can show which plan was checked. evidence is empty and plan_years_listed is [].
{ "data": { "npi": "1376006148", "plan_id": "13262AR0230002", "input_plan_id": "13262AR0230002", "market": "aca", "plan_years_listed": [], "in_network": null, "answer": "not_found", "explanation": "No listing found in current directory data for this provider and plan.", "evidence": [], "plan_year": 2026, "plan": { "plan_name": "HA Silver AH", "issuer": { "id": "13262", "name": "Health Advantage" }, "state": "AR", "metal_level": "Silver", "plan_type": "POS", "variant": null }, "source": { "type": "insurer_directory", "as_of": "2026-10-28" }, "as_of": "2026-10-28" }, "notes": [ "in_network=null means no listing was found in current directory data. It is not a statement that the provider is out of network.", "Network directories change. Confirm with the plan or the provider before care." ]}
Source types
We name sources by type. The sources array of every response lists the types behind it, each with the date it is current to.
| TYPE | WHAT IT IS |
|---|---|
insurer_directory | Provider network directories published by health insurers (marketplace plans). |
plan_directory | Provider network directories published by Medicare Advantage plans. |
provider_registry | National provider registry and practice records: names, credentials, specialties, locations. |
plan_catalog | Published health plan catalogs: plan names, insurers, metal levels, plan types. |