Provider

Owns the provider directory, credentialing workflow, and network participation status.

Overview

The Provider service is the authoritative registry for healthcare providers (physicians, facilities, labs) that participate in Olly's network. It stores provider entities with their NPI numbers, specialties, and contact information, and manages the credentialing lifecycle that a provider must complete before being marked as in-network.

Credentialing requests capture the application, supporting documentation references, and approval or rejection decisions. The service integrates with Policy Admin to validate network participation requirements against plan configurations. Once a provider is credentialed and activated, other services (Claims, Care) look up providers via the internal NPI endpoint.

Responsibilities

• Maintain the provider master directory (create, update, activate, deactivate providers)
• Accept and process credentialing applications with approval/rejection workflows
• Report network status (in-network / out-of-network) for a given NPI
• Serve internal provider lookups by NPI for Claims and Care
• Support provider search for member-facing and admin interfaces

Database

Schema: provider

Table	Purpose
providers	Provider entities with NPI, specialty, contact info, and network status
credentialing_requests	Credentialing applications with lifecycle status (PENDING → APPROVED/REJECTED)
seq_tables	Sequence tables for locator generation

API Routes

Method	Path	Auth	Description
POST	/providers	JWT	Create a new provider record
GET	/providers	JWT	List providers
GET	/providers/{locator}	JWT	Get provider by locator
PATCH	/providers/{locator}	JWT	Update provider details
PATCH	/providers/{locator}/activate	JWT	Activate a provider
PATCH	/providers/{locator}/deactivate	JWT	Deactivate a provider
POST	/credentialing	JWT	Submit a credentialing application
GET	/credentialing	JWT	List credentialing requests
GET	/credentialing/{locator}	JWT	Get credentialing request by locator
PATCH	/credentialing/{locator}/approve	JWT	Approve a credentialing request
PATCH	/credentialing/{locator}/reject	JWT	Reject a credentialing request
GET	/credentialing/{npi}/status	JWT	Get network status for an NPI
GET	/internal/providers/{npi}	Internal	Fetch provider by NPI (no JWT)

Events

Publishes

The Provider service does not currently publish Kafka events.

Consumes

The Provider service does not consume Kafka events.

Dependencies

Service	How used
Policy Admin	Validates network tier and plan participation requirements during credentialing

Key Design Decisions

NPI as the lookup key: The internal GET /internal/providers/{npi} endpoint uses the National Provider Identifier rather than an internal locator. This is because upstream systems (Claims EDI, Care appointment booking) receive NPI values from external sources and need to resolve them to Olly provider records.

Credentialing as a first-class entity: Rather than a simple boolean flag on the provider record, credentialing is modelled as a separate entity with its own lifecycle. This allows multiple credentialing rounds, partial approvals, and a full audit trail of the credentialing history.