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

## Resource Profile: RTPBC Request Using Claim - Non-PHI - Mappings

Page standards status: Trial-use | Maturity Level: 4

Mappings for the rtpbc-request-claim-non-phi resource profile.

#### Mappings to Structures in this Implementation Guide

No Mappings Found

#### Mappings to other Structures

No Mappings Found

#### Other Mappings

Name | Workflow Pattern | FiveWs Pattern Mapping | RIM Mapping
--- | --- | --- | ---
Claim | Request |  | Entity. Role or Act
id |  |  |
meta |  |  |
implicitRules |  |  |
language |  |  |
text |  |  | Act.text?
contained |  |  | N/A
extension |  |  | N/A
modifierExtension |  |  | N/A
identifier | Request.identifier | FiveWs.identifier |
id |  |  | n/a
extension |  |  | n/a
use |  |  | Role.code or implied by context
type |  |  | Role.code or implied by context
system |  |  | II.root or Role.id.root
value |  |  | II.extension or II.root if system indicates OID or GUID (Or Role.id.extension or root)
period |  |  | Role.effectiveTime or implied by context
assigner |  |  | II.assigningAuthorityName but note that this is an improper use by the definition of the field. Also Role.scoper
status | Request.status | FiveWs.status |
type |  | FiveWs.class |
id |  |  | n/a
extension |  |  | n/a
coding |  |  | union(. ./translation)
id |  |  | n/a
extension |  |  | n/a
system |  |  | ./codeSystem
version |  |  | ./codeSystemVersion
code |  |  | ./code
display |  |  | CV.displayName
userSelected |  |  | CD.codingRationale
text |  |  | ./originalText[mediaType/code="text/plain"]/data
subType |  | FiveWs.class |
use |  | FiveWs.class |
patient | Request.subject | FiveWs.subject |
id |  |  | n/a
extension |  |  | n/a
reference |  |  | N/A
type |  |  | N/A
identifier |  |  | .identifier
display |  |  | N/A
billablePeriod |  | FiveWs.done[x] |
created | Request.authoredOn | FiveWs.recorded |
enterer |  | FiveWs.author |
insurer | Request.performer |  |
provider | Request.requester | FiveWs.source |
id |  |  | n/a
extension |  |  | n/a
reference |  |  | N/A
type |  |  | N/A
identifier |  |  | .identifier
display |  |  | N/A
priority | Request.priority |  |
id |  |  | n/a
extension |  |  | n/a
coding |  |  | union(. ./translation)
id |  |  | n/a
extension |  |  | n/a
system |  |  | ./codeSystem
version |  |  | ./codeSystemVersion
code |  |  | ./code
display |  |  | CV.displayName
userSelected |  |  | CD.codingRationale
text |  |  | ./originalText[mediaType/code="text/plain"]/data
fundsReserve |  |  |
related |  |  |
id |  |  | n/a
extension |  |  | n/a
modifierExtension |  |  | N/A
claim | Request.replaces |  |
relationship |  |  |
reference |  |  |
prescription |  |  |
id |  |  | n/a
extension |  |  | n/a
reference |  |  | N/A
type |  |  | N/A
identifier |  |  | .identifier
display |  |  | N/A
originalPrescription |  |  |
payee |  |  |
id |  |  | n/a
extension |  |  | n/a
modifierExtension |  |  | N/A
type |  |  |
party |  |  |
referral |  | FiveWs.cause |
facility |  | FiveWs.where[x] |
careTeam |  |  |
id |  |  | n/a
extension |  |  | n/a
modifierExtension |  |  | N/A
sequence |  |  |
provider |  | FiveWs.actor |
id |  |  | n/a
extension |  |  | n/a
reference |  |  | N/A
type |  |  | N/A
identifier |  |  | .identifier
display |  |  | N/A
responsible |  |  |
role |  |  |
qualification |  |  |
supportingInfo | Request.supportingInfo |  |
id |  |  | n/a
extension |  |  | n/a
modifierExtension |  |  | N/A
sequence |  |  |
category |  |  |
code |  |  |
timing[x] |  |  |
value[x] |  |  |
reason |  |  |
diagnosis | Request.reasonReference |  |
id |  |  | n/a
extension |  |  | n/a
modifierExtension |  |  | N/A
sequence |  |  |
diagnosis[x] |  |  |
type |  |  |
onAdmission |  |  |
packageCode |  |  |
procedure |  |  |
id |  |  | n/a
extension |  |  | n/a
modifierExtension |  |  | N/A
sequence |  |  |
type |  |  |
date |  |  |
procedure[x] |  |  |
udi |  |  |
insurance |  |  | Coverage
id |  |  | n/a
extension |  |  | n/a
modifierExtension |  |  | N/A
sequence |  |  |
focal |  |  |
identifier | Request.identifier | FiveWs.identifier |
coverage |  |  |
id |  |  | n/a
extension |  |  | n/a
reference |  |  | N/A
type |  |  | N/A
identifier |  |  | .identifier
display |  |  | N/A
businessArrangement |  |  |
preAuthRef |  |  |
claimResponse |  |  |
accident |  |  |
id |  |  | n/a
extension |  |  | n/a
modifierExtension |  |  | N/A
date |  |  |
type |  |  |
location[x] |  |  |
item |  |  |
id |  |  | n/a
extension |  |  | n/a
modifierExtension |  |  | N/A
sequence |  |  |
careTeamSequence |  |  |
diagnosisSequence |  |  |
procedureSequence |  |  |
informationSequence |  |  |
revenue |  |  |
category |  |  |
productOrService |  |  |
id |  |  | n/a
extension |  |  | n/a
coding |  |  | union(. ./translation)
id |  |  | n/a
extension |  |  | n/a
system |  |  | ./codeSystem
version |  |  | ./codeSystemVersion
code |  |  | ./code
display |  |  | CV.displayName
userSelected |  |  | CD.codingRationale
text |  |  | ./originalText[mediaType/code="text/plain"]/data
modifier |  |  |
programCode |  |  |
serviced[x] |  | FiveWs.done[x] |
location[x] |  | FiveWs.where[x] |
quantity |  |  |
id |  |  | n/a
extension |  |  | n/a
value |  |  | PQ.value CO.value MO.value IVL.high or IVL.low depending on the value
comparator |  |  | IVL properties
unit |  |  | PQ.unit
system |  |  | CO.codeSystem PQ.translation.codeSystem
code |  |  | PQ.code MO.currency PQ.translation.code
unitPrice |  |  |
factor |  |  |
net |  |  |
udi |  |  |
bodySite |  |  |
subSite |  |  |
encounter | Request.context |  |
detail |  |  |
id |  |  | n/a
extension |  |  | n/a
modifierExtension |  |  | N/A
sequence |  |  |
revenue |  |  |
category |  |  |
productOrService |  |  |
modifier |  |  |
programCode |  |  |
quantity |  |  |
unitPrice |  |  |
factor |  |  |
net |  |  |
udi |  |  |
subDetail |  |  |
id |  |  | n/a
extension |  |  | n/a
modifierExtension |  |  | N/A
sequence |  |  |
revenue |  |  |
category |  |  |
productOrService |  |  |
modifier |  |  |
programCode |  |  |
quantity |  |  |
unitPrice |  |  |
factor |  |  |
net |  |  |
udi |  |  |
total |  |  |
Documentation for this format