Consumer Real-Time Pharmacy Benefit Check FHIR IG
2.0.0 - CI Build
Consumer Real-Time Pharmacy Benefit Check FHIR IG
2.0.0 - CI Build
Consumer Real-Time Pharmacy Benefit Check FHIR IG, published by HL7 International / Pharmacy. This guide is not an authorized publication; it is the continuous build for version 2.0.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/carin-rtpbc/ and changes regularly. See the Directory of published versions
{
"resourceType" : "Bundle",
"id" : "rtpbc-bundle-response-03",
"meta" : {
"profile" : [
🔗 "http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-response-bundle"
]
},
"language" : "en",
"type" : "message",
"timestamp" : "2019-11-15T13:10:15-05:00",
"entry" : [
{
"fullUrl" : "http://example.org/my-app/MessageHeader/rtpbc-messageheader-response-03wh",
"resource" : {
"resourceType" : "MessageHeader",
"id" : "rtpbc-messageheader-response-03wh",
"meta" : {
"profile" : [
🔗 "http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-response-messageheader"
]
},
"language" : "en",
"text" : {
"status" : "generated",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"MessageHeader_rtpbc-messageheader-response-03wh\"> </a><p class=\"res-header-id\"><b>Generated Narrative: MessageHeader rtpbc-messageheader-response-03wh</b></p><a name=\"rtpbc-messageheader-response-03wh\"> </a><a name=\"hcrtpbc-messageheader-response-03wh\"> </a><div style=\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\"><p style=\"margin-bottom: 0px\"/><p style=\"margin-bottom: 0px\">Profile: <a href=\"StructureDefinition-rtpbc-response-messageheader.html\">RTPBC Response MessageHeader</a></p></div><p><b>event</b>: <a href=\"CodeSystem-rtpbc-event-type.html#rtpbc-event-type-rtpbc-response\">RTPBC Event Type Code System: rtpbc-response</a> (RTPBC Response)</p><h3>Sources</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Name</b></td><td><b>Endpoint</b></td></tr><tr><td style=\"display: none\">*</td><td>PharmacyBenefitsCompany</td><td><a href=\"http://example.org/PharmacyBenefitsCo/fhir\">http://example.org/PharmacyBenefitsCo/fhir</a></td></tr></table><h3>Responses</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Identifier</b></td><td><b>Code</b></td></tr><tr><td style=\"display: none\">*</td><td>rtpbc-messageheader-request-03</td><td>OK</td></tr></table><p><b>focus</b>: <a href=\"Bundle-rtpbc-bundle-response-03.html#http-//example.org/my-app/ClaimResponse/rtpbc-claim-response-03wh\">ClaimResponse: identifier = rtpbc-03-response; status = active; type = Pharmacy; use = predetermination; created = 2019-11-01 11:20:59-0500; outcome = complete; disposition = Processed successfully</a></p><p><b>definition</b>: <a href=\"MessageDefinition-rtpbc-response.html\">RTPBC Response Message Definition</a></p></div>"
},
"eventCoding" : {
"system" : "http://hl7.org/fhir/us/carin-rtpbc/CodeSystem/rtpbc-event-type",
"code" : "rtpbc-response",
"display" : "RTPBC Response"
},
"source" : {
"name" : "PharmacyBenefitsCompany",
"endpoint" : "http://example.org/PharmacyBenefitsCo/fhir"
},
"response" : {
"identifier" : "rtpbc-messageheader-request-03",
"code" : "ok"
},
"focus" : [
{
"reference" : "http://example.org/my-app/ClaimResponse/rtpbc-claim-response-03wh"
}
],
"definition" : "http://hl7.org/fhir/us/carin-rtpbc/MessageDefinition/rtpbc-response"
}
},
{
"fullUrl" : "http://example.org/my-app/ClaimResponse/rtpbc-claim-response-03wh",
"resource" : {
"resourceType" : "ClaimResponse",
"id" : "rtpbc-claim-response-03wh",
"meta" : {
"profile" : [
🔗 "http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-response-claimresponse"
]
},
"language" : "en",
"text" : {
"status" : "extensions",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"ClaimResponse_rtpbc-claim-response-03wh\"> </a><p class=\"res-header-id\"><b>Generated Narrative: ClaimResponse rtpbc-claim-response-03wh</b></p><a name=\"rtpbc-claim-response-03wh\"> </a><a name=\"hcrtpbc-claim-response-03wh\"> </a><div style=\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\"><p style=\"margin-bottom: 0px\"/><p style=\"margin-bottom: 0px\">Profile: <a href=\"StructureDefinition-rtpbc-response-claimresponse.html\">RTPBC Response Using ClaimResponse</a></p></div><p><b>identifier</b>: rtpbc-03-response</p><p><b>status</b>: Active</p><p><b>type</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/claim-type pharmacy}\">Pharmacy</span></p><p><b>use</b>: Predetermination</p><p><b>patient</b>: <a href=\"Patient-rtpbc-patient-03.html\">Jane Doe Female, DoB: 1975-12-05 ( Patient internal identifier:\u00a030455)</a></p><p><b>created</b>: 2019-11-01 11:20:59-0500</p><p><b>insurer</b>: Identifier: Pharmacy Plans US</p><p><b>request</b>: Identifier: rtpbc-03</p><p><b>outcome</b>: Processing Complete</p><p><b>disposition</b>: Processed successfully</p><blockquote><p><b>item</b></p><p><b>RTPBC benefitRestriction Extension</b>: <a href=\"CodeSystem-rtpbc-benefit-restriction.html#rtpbc-benefit-restriction-prior-auth\">RTPBC Benefit Restriction Code System: prior-auth</a> (Prior authorization required)</p><p><b>itemSequence</b>: 1</p><blockquote><p><b>adjudication</b></p><p><b>category</b>: <span title=\"Codes:{http://hl7.org/fhir/us/carin-rtpbc/CodeSystem/rtpbc-patient-pay-type copay}\">Copay</span></p><h3>Amounts</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style=\"display: none\">*</td><td>40</td><td>United States dollar</td></tr></table></blockquote><blockquote><p><b>adjudication</b></p><p><b>category</b>: <span title=\"Codes:{http://hl7.org/fhir/us/carin-rtpbc/CodeSystem/rtpbc-patient-pay-type coinsurance}\">Per prescription coinsurance</span></p><h3>Amounts</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style=\"display: none\">*</td><td>30</td><td>United States dollar</td></tr></table></blockquote><blockquote><p><b>adjudication</b></p><p><b>category</b>: <span title=\"Codes:{http://hl7.org/fhir/us/carin-rtpbc/CodeSystem/rtpbc-patient-pay-type total}\">Total patient responsibility</span></p><h3>Amounts</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style=\"display: none\">*</td><td>70</td><td>United States dollar</td></tr></table></blockquote></blockquote><blockquote><p><b>addItem</b></p><p><b>RTPBC isAlternative Extension</b>: true</p><p><b>RTPBC benefitRestriction Extension</b>: <a href=\"CodeSystem-rtpbc-benefit-restriction.html#rtpbc-benefit-restriction-covered\">RTPBC Benefit Restriction Code System: covered</a> (Covered)</p><p><b>itemSequence</b>: 1</p><p><b>provider</b>: <a href=\"Organization-rtpbc-organization-03m.html\">Organization My Mail Service Pharmacy</a></p><p><b>productOrService</b>: <span title=\"Codes:{http://www.nlm.nih.gov/research/umls/rxnorm 205535}\">fluoxetine 10 MG Oral Capsule [Prozac]</span></p><p><b>quantity</b>: 180 {Each}</p><blockquote><p><b>adjudication</b></p><p><b>category</b>: <span title=\"Codes:{http://hl7.org/fhir/us/carin-rtpbc/CodeSystem/rtpbc-patient-pay-type copay}\">Copay</span></p><h3>Amounts</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style=\"display: none\">*</td><td>20</td><td>United States dollar</td></tr></table></blockquote><blockquote><p><b>adjudication</b></p><p><b>category</b>: <span title=\"Codes:{http://hl7.org/fhir/us/carin-rtpbc/CodeSystem/rtpbc-patient-pay-type coinsurance}\">Per prescription coinsurance</span></p><h3>Amounts</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style=\"display: none\">*</td><td>30</td><td>United States dollar</td></tr></table></blockquote><blockquote><p><b>adjudication</b></p><p><b>category</b>: <span title=\"Codes:{http://hl7.org/fhir/us/carin-rtpbc/CodeSystem/rtpbc-patient-pay-type total}\">Total patient responsibility</span></p><h3>Amounts</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style=\"display: none\">*</td><td>50</td><td>United States dollar</td></tr></table></blockquote></blockquote></div>"
},
"identifier" : [
{
"value" : "rtpbc-03-response"
}
],
"status" : "active",
"type" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/claim-type",
"code" : "pharmacy",
"display" : "Pharmacy"
}
]
},
"use" : "predetermination",
"patient" : {
🔗 "reference" : "Patient/rtpbc-patient-03"
},
"created" : "2019-11-01T11:20:59-05:00",
"insurer" : {
"identifier" : {
"value" : "Pharmacy Plans US"
}
},
"request" : {
"identifier" : {
"value" : "rtpbc-03"
}
},
"outcome" : "complete",
"disposition" : "Processed successfully",
"item" : [
{
"extension" : [
{
"url" : "http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-benefitRestriction",
"valueCoding" : {
"system" : "http://hl7.org/fhir/us/carin-rtpbc/CodeSystem/rtpbc-benefit-restriction",
"code" : "prior-auth",
"display" : "Prior authorization required"
}
}
],
"itemSequence" : 1,
"adjudication" : [
{
"category" : {
"coding" : [
{
"system" : "http://hl7.org/fhir/us/carin-rtpbc/CodeSystem/rtpbc-patient-pay-type",
"code" : "copay",
"display" : "Copay"
}
]
},
"amount" : {
"value" : 40,
"currency" : "USD"
}
},
{
"category" : {
"coding" : [
{
"system" : "http://hl7.org/fhir/us/carin-rtpbc/CodeSystem/rtpbc-patient-pay-type",
"code" : "coinsurance",
"display" : "Per prescription coinsurance"
}
]
},
"amount" : {
"value" : 30,
"currency" : "USD"
}
},
{
"category" : {
"coding" : [
{
"system" : "http://hl7.org/fhir/us/carin-rtpbc/CodeSystem/rtpbc-patient-pay-type",
"code" : "total",
"display" : "Total patient responsibility"
}
]
},
"amount" : {
"value" : 70,
"currency" : "USD"
}
}
]
}
],
"addItem" : [
{
"extension" : [
{
"url" : "http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-isAlternative",
"valueBoolean" : true
},
{
"url" : "http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-benefitRestriction",
"valueCoding" : {
"system" : "http://hl7.org/fhir/us/carin-rtpbc/CodeSystem/rtpbc-benefit-restriction",
"code" : "covered",
"display" : "Covered"
}
}
],
"itemSequence" : [
1
],
"provider" : [
{
🔗 "reference" : "Organization/rtpbc-organization-03m"
}
],
"productOrService" : {
"coding" : [
{
"system" : "http://www.nlm.nih.gov/research/umls/rxnorm",
"code" : "205535",
"display" : "fluoxetine 10 MG Oral Capsule [Prozac]"
}
]
},
"quantity" : {
"value" : 180,
"unit" : "{Each}"
},
"adjudication" : [
{
"category" : {
"coding" : [
{
"system" : "http://hl7.org/fhir/us/carin-rtpbc/CodeSystem/rtpbc-patient-pay-type",
"code" : "copay",
"display" : "Copay"
}
]
},
"amount" : {
"value" : 20,
"currency" : "USD"
}
},
{
"category" : {
"coding" : [
{
"system" : "http://hl7.org/fhir/us/carin-rtpbc/CodeSystem/rtpbc-patient-pay-type",
"code" : "coinsurance",
"display" : "Per prescription coinsurance"
}
]
},
"amount" : {
"value" : 30,
"currency" : "USD"
}
},
{
"category" : {
"coding" : [
{
"system" : "http://hl7.org/fhir/us/carin-rtpbc/CodeSystem/rtpbc-patient-pay-type",
"code" : "total",
"display" : "Total patient responsibility"
}
]
},
"amount" : {
"value" : 50,
"currency" : "USD"
}
}
]
}
]
}
},
{
"fullUrl" : "http://example.org/my-app/Patient/rtpbc-patient-03",
"resource" : {
"resourceType" : "Patient",
"id" : "rtpbc-patient-03",
"meta" : {
"profile" : [
🔗 "http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-patient"
]
},
"language" : "en",
"text" : {
"status" : "generated",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"Patient_rtpbc-patient-03\"> </a><p class=\"res-header-id\"><b>Generated Narrative: Patient rtpbc-patient-03</b></p><a name=\"rtpbc-patient-03\"> </a><a name=\"hcrtpbc-patient-03\"> </a><div style=\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\"><p style=\"margin-bottom: 0px\"/><p style=\"margin-bottom: 0px\">Profile: <a href=\"StructureDefinition-rtpbc-patient.html\">RTPBC Patient</a></p></div><p style=\"border: 1px #661aff solid; background-color: #e6e6ff; padding: 10px;\">Jane Doe Female, DoB: 1975-12-05 ( Patient internal identifier:\u00a030455)</p><hr/><table class=\"grid\"><tr><td style=\"background-color: #f3f5da\" title=\"Ways to contact the Patient\">Contact Detail</td><td colspan=\"3\">100 Oak Court Madison WI 53510 US </td></tr></table></div>"
},
"identifier" : [
{
"type" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/v2-0203",
"code" : "PI",
"display" : "Patient internal identifier"
}
],
"text" : "Patient internal identifier"
},
"system" : "http://example.org/MyPatientApp",
"value" : "30455"
}
],
"name" : [
{
"family" : "Doe",
"given" : [
"Jane"
]
}
],
"gender" : "female",
"birthDate" : "1975-12-05",
"address" : [
{
"line" : [
"100 Oak Court"
],
"city" : "Madison",
"state" : "WI",
"postalCode" : "53510",
"country" : "US"
}
]
}
},
{
"fullUrl" : "http://example.org/my-app/Organization/rtpbc-organization-03m",
"resource" : {
"resourceType" : "Organization",
"id" : "rtpbc-organization-03m",
"meta" : {
"profile" : [
🔗 "http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-pharmacy-organization"
]
},
"language" : "en",
"text" : {
"status" : "generated",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"Organization_rtpbc-organization-03m\"> </a><p class=\"res-header-id\"><b>Generated Narrative: Organization rtpbc-organization-03m</b></p><a name=\"rtpbc-organization-03m\"> </a><a name=\"hcrtpbc-organization-03m\"> </a><div style=\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\"><p style=\"margin-bottom: 0px\"/><p style=\"margin-bottom: 0px\">Profile: <a href=\"StructureDefinition-rtpbc-pharmacy-organization.html\">RTPBC Pharmacy Organization</a></p></div><p><b>identifier</b>: <a href=\"http://terminology.hl7.org/5.5.0/NamingSystem-NCPDPProviderIdentificationNumber.html\" title=\"A NCPDP assigned number that provides pharmacies with a unique, 7-digit national identifying number that assists pharmacies in their interactions with federal agencies and third party providers. The NCPDP Provider Identification Number was formerly known as the NABP (National Board of Pharmacy) number. NCPDP also enumerates licensed dispensing sites in the United States as part of its Alternate Site Enumeration Program Numbering System (ASEP). The purpose of this system is to enable a site to identify itself to all third party processors by one standard number, in order to adjudicate claims and receive reimbursement from prescription card programs.\">NCPDP Provider Identification Number</a>/0999029</p><p><b>active</b>: true</p><p><b>type</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/NCPDPPharmacyType M}\">Mail Order</span></p><p><b>name</b>: My Mail Service Pharmacy</p><p><b>telecom</b>: ph: 5551234567</p><p><b>address</b>: 10001 Oakland Road Milwaukee WI 54444 US </p></div>"
},
"identifier" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/NCPDPProviderIdentificationNumber",
"value" : "0999029"
}
],
"active" : true,
"type" : [
{
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/NCPDPPharmacyType",
"code" : "M",
"display" : "Mail Order"
}
]
}
],
"name" : "My Mail Service Pharmacy",
"telecom" : [
{
"system" : "phone",
"value" : "5551234567"
}
],
"address" : [
{
"line" : [
"10001 Oakland Road"
],
"city" : "Milwaukee",
"state" : "WI",
"postalCode" : "54444",
"country" : "US"
}
]
}
}
]
}
IG © 2024+ HL7 International / Pharmacy.
Package hl7.fhir.us.carin-rtpbc#2.0.0 based on FHIR 4.0.1.
Generated
2025-12-16
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