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VA Technical Reference Model v 26.1

HL7 FHIR PDex Payer Network
HL7 FHIR PDex Payer Network Standard or Specification

General Information

Technologies must be operated and maintained in accordance with Federal and Department security and privacy policies and guidelines. More information on the proper use of the TRM can be found on the TRM Proper Use Tab/Section.

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Description: 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.
Technology/Standard Usage Requirements: Users must ensure their use of this technology/standard is consistent with VA policies and standards, including, but not limited to, VA Handbooks 6102 and 6500; VA Directives 6004, 6513, and 6517; and National Institute of Standards and Technology (NIST) standards, including Federal Information Processing Standards (FIPS). Users must ensure sensitive data is properly protected in compliance with all VA regulations. Prior to use of this technology, users should check with their supervisor, Information System Security Officer (ISSO), Facility Chief Information Officer (CIO), or local Office of Information and Technology (OI&T) representative to ensure that all actions are consistent with current VA policies and procedures prior to implementation.
Section 508 Information:
Decision: View Decisions
Decision Source: TRM Mgmt Group
Decision Process: One-VA TRM v25.11
Decision Date: 11/21/2025 at 17:32:15 UTC
Aliases: "HL7 FHIR Implementation Guide: Payer Data Exchange (PDex) Payer Network, Release 1 - US Realm", "HL7 FHIR IG: PDex Payer Network, R1 - US Realm", PDex, Plan-Net, Plan Net, Provider Directory
Introduced By: TRM Request
Standards Body: HL7
Cage Code: 3ZPX5
- The information contained on this page is accurate as of the Decision Date (11/21/2025 at 17:32:15 UTC).