HL7 FHIR® Implementation Guide: Payer Data Exchange (PDex) Payer Network, Release 1.1 – US Realm

This implementation guide defines a FHIR interface to a health insurer’s insurance plans, their associated networks, and the organizations and providers that participate in these networks. Publication of this data through a standard FHIR-based API will enable third parties to develop applications through which consumers and providers can query the participants in a payer’s network that may provide services that address their health care needs. Although there are multiple types and sources of providers’ directories, including provider organizations (i.e., a hospital listing all its physicians), government (i.e., listing of providers in Medicare), payers (i.e., a health plan’s provider network), and third-party entities (such as vendors that maintain provider directories), the focus of this implementation guide is on Payer Provider Directories.