Example RTPBC request scenario using FHIR messaging

In this example:

• the client is a patient application
• the server is the patient's insurer (specifically, the party that manages the patient's pharmacy benefit)
• the request is submitted as a Bundle containing a Claim and supporting resources, as the single parameter to the processor's $process-message operation

Content:

• the patient's name is Jane Doe, date of birth is 1975-12-05, and address is 100 Oak Court, Madison, WI 53510
• the requested medication is Prozac 10mg capsule, 60 capsules, for a 30 day supply (reflected in the Claim and MedicationRequest resources)
• the prescriber's identifying information is captured in the Practitioner resource
• the requested pharmacy is Hometown Drug (reflected in the Organization resource)
• the patient's coverage identifiers (BIN/PCN, member ID) are conveyed in a Coverage resource

The supporting data (patient, coverage, prescription, etc.) consists of identifying information that the processor will use to locate the patient's insurance record and coverage rules applying to the medication, pharmacy and prescriber.

Bundle rtpbc-bundle-request-03 of type message

Entry 1 - fullUrl = http://example.org/my-app/MessageHeader/rtpbc-messageheader-request-03a

Resource MessageHeader:

Language: en

Profile: RTPBC Request MessageHeader

event: RTPBC Event Type Code System: rtpbc-request (RTPBC Request)

Sources

-	Name
*	MyPatientApp

focus: Claim: identifier = rtpbc-03a; status = active; type = Pharmacy; use = predetermination; created = 2019-11-01 11:20:54-0500; priority = Normal

definition: RTPBC Request Message Definition

Entry 2 - fullUrl = http://example.org/my-app/Claim/rtpbc-claim-03a

Resource Claim:

Language: en

Profile: RTPBC Request Using Claim

identifier: rtpbc-03a

status: Active

type: Pharmacy

use: Predetermination

patient: Jane Doe Female, DoB: 1975-12-05 ( Patient internal identifier: 30455)

created: 2019-11-01 11:20:54-0500

provider: Organization Hometown Drug

priority: Normal

prescription: MedicationRequest: status = draft; intent = proposal; reported[x] = true; medication[x] = fluoxetine 10 MG Oral Capsule [Prozac]; authoredOn = 2019-11-01

CareTeams

-	Sequence	Provider
*	1	Practitioner Johnson

Insurances

-	Sequence	Focal	Coverage
*	1	true	Coverage: status = active; subscriberId = 121212; relationship = Self

Items

-	Sequence	CareTeamSequence	ProductOrService	Quantity
*	1	1	fluoxetine 10 MG Oral Capsule [Prozac]	60 {Each}

Entry 3 - fullUrl = http://example.org/my-app/Patient/rtpbc-patient-03

Resource Patient:

Language: en

Profile: RTPBC Patient

Jane Doe Female, DoB: 1975-12-05 ( Patient internal identifier: 30455)

---

Contact Detail

100 Oak Court Madison WI 53510 US

Entry 4 - fullUrl = http://example.org/my-app/Coverage/rtpbc-coverage-01

Resource Coverage:

Language: en

Profile: RTPBC Coverage

status: Active

subscriberId: 121212

beneficiary: Jane Doe Female, DoB: 1975-12-05 ( Patient internal identifier: 30455)

relationship: Self

class

type: RX BIN

value: BIN001

class

type: RX PCN

value: PCN002

class

type: RX Group

value: GROUP0001

class

type: RX Id

value: MEMBER000001

Entry 5 - fullUrl = http://example.org/my-app/MedicationRequest/rtpbc-medicationrequest-03

Resource MedicationRequest:

Language: en

Profile: RTPBC Medication Request

status: Draft

intent: Proposal

subject: Jane Doe Female, DoB: 1975-12-05 ( Patient internal identifier: 30455)

authoredOn: 2019-11-01

requester: Practitioner Johnson

DosageInstructions

-	Text
*	Take 2 capsules once a day

dispenseRequest

quantity: 60 {Each}

ExpectedSupplyDurations

-	Value	Unit	System	Code
*	30	days	http://unitsofmeasure.org	d

Substitutions

-	Allowed[x]
*	false

Entry 6 - fullUrl = http://example.org/my-app/Practitioner/rtpbc-practitioner-03

Resource Practitioner:

Language: en

Profile: US Core Practitioner Profile

identifier: United States National Provider Identifier/1234567893

name: Johnson

Entry 7 - fullUrl = http://example.org/my-app/Organization/rtpbc-organization-03

Resource Organization:

Language: en

Profile: RTPBC Pharmacy Organization

identifier: United States National Provider Identifier/9876543213

active: true

type: Retail

name: Hometown Drug

Contacts

-	Telecom	Address
*	ph: 6081234567	900 9th Street Madison WI 53535 US