{
  "slug": "ndh-payer-endpoint-coverage",
  "title": "NDH payer endpoint and organization coverage",
  "hypotheses": [
    "H49"
  ],
  "status": "published",
  "release_date": "2026-08-20",
  "generated_at": "2026-08-20T22:26:38+00:00",
  "methodology_version": "0.7.2-draft",
  "commit_sha": "5d36703",
  "headline": "CMS added payer organizations in the 2026-08-20 release: 27 carry a 'pay' type coding and own 233 Medicare Advantage plans, where the previous release had no payer type at all. Payer endpoints did not follow. 0 of the 27 payer organizations carry an endpoint, 1 of 110,973 FHIR REST endpoints is a payer provider directory, and a live CMS-9115-F directory is still absent from the index.",
  "numerator": 1,
  "denominator": 110973,
  "chart": {
    "type": "bar",
    "unit": "count",
    "data": [
      {
        "label": "Payer organizations (type pay)",
        "value": 27
      },
      {
        "label": "Medicare Advantage plans",
        "value": 233
      },
      {
        "label": "Payer orgs carrying an endpoint",
        "value": 0
      },
      {
        "label": "Payer provider-directory endpoints",
        "value": 1
      }
    ]
  },
  "notes": "Re-measured against the 2026-08-20 release by streaming the published NDJSON directly, not through BigQuery, so the check could run the day the release landed rather than after a 45 GB ingest. Classification constants are imported from analysis/h49_ndh_payer_endpoints.py rather than copied, so this cannot drift from the finding it updates. Half of the original result is resolved: a payer organization type now exists. The other half stands: no payer organization carries an endpoint, and the control directory (Capital BlueCross) answers 200 to an unauthenticated request while remaining absent from the index, which separates 'nothing to index' from 'not indexed yet'. Reproduce with analysis/h49_recheck_release.py --dir <release dir>.",
  "detail": {
    "organization_type_codings": [
      {
        "code": "prov",
        "display": "Healthcare Provider",
        "count": 1999118
      },
      {
        "code": "team",
        "display": "Organizational team",
        "count": 639
      },
      {
        "code": "govt",
        "display": "Government",
        "count": 61
      }
    ],
    "distinct_endpoint_hosts": 2962,
    "payer_operated_hosts": 58,
    "payer_endpoint_rows": 92,
    "payer_endpoint_status": {
      "error": 30,
      "active": 62
    },
    "payer_endpoints_with_managing_org": 7,
    "control_directories": [
      {
        "payer": "Capital BlueCross",
        "state": "PA",
        "base": "https://providerdirectory-api.capbluecross.com/r4",
        "probe": "/Practitioner?family=Smith&_count=1",
        "http_status": 200,
        "bytes": 1821,
        "live_public": true,
        "present_in_ndh": false
      }
    ],
    "live_but_absent_from_ndh": 1
  }
}