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

## : rtpbc-claim-response-03-price-source

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    @prefix fhir: <http://hl7.org/fhir/> .
    @prefix owl: <http://www.w3.org/2002/07/owl#> .
    @prefix rdf: <http://www.w3.org/1999/02/22-rdf-syntax-ns#> .
    @prefix rdfs: <http://www.w3.org/2000/01/rdf-schema#> .
    @prefix xsd: <http://www.w3.org/2001/XMLSchema#> .

    # - resource -------------------------------------------------------------------

     a fhir:ClaimResponse ;
      fhir:nodeRole fhir:treeRoot ;
      fhir:id [ fhir:v "rtpbc-claim-response-03-price-source"] ; #
      fhir:meta [
        ( fhir:profile [
    fhir:v "http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-response-claimresponse"^^xsd:anyURI ;
    fhir:l <http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-response-claimresponse>     ] )
      ] ; #
      fhir:language [ fhir:v "en"] ; #
      fhir:text [
    fhir:status [ fhir:v "extensions" ] ;
    fhir:div [ fhir:v "<div xmlns=\"http://www.w3.org/1999/xhtml\" xml:lang=\"en\" lang=\"en\"><p class=\"res-header-id\"><b>Generated Narrative: ClaimResponse rtpbc-claim-response-03-price-source</b></p><a name=\"rtpbc-claim-response-03-price-source\"> </a><a name=\"hcrtpbc-claim-response-03-price-source\"> </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\">Language: en</p><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-price-source</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-03ps.html\">Jane Doe  Female, DoB: 1975-12-05 ( Patient internal identifier: 30455)</a></p><p><b>created</b>: 2019-11-01 11:20:59-0500</p><p><b>insurer</b>: Identifier: GoodPricing</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>itemSequence</b>: 1</p><p><b>noteNumber</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 cash-price}\">Full product cash price</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>105</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 coupon-discount}\">Coupon discount amount</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 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>85</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>itemSequence</b>: 1</p><p><b>provider</b>: <a href=\"Organization-rtpbc-organization-03ps.html\">Organization Home Drugs</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>: 60 {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 cash-price}\">Full product cash price</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><p><b>adjudication</b></p><p><b>category</b>: <span title=\"Codes:{http://hl7.org/fhir/us/carin-rtpbc/CodeSystem/rtpbc-patient-pay-type coupon-discount}\">Coupon discount amount</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>-10</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>40</td><td>United States dollar</td></tr></table></blockquote></blockquote></div>"^^rdf:XMLLiteral ]
      ] ; #
      fhir:identifier ( [
    fhir:value [ fhir:v "rtpbc-03-response-price-source" ]
      ] ) ; #
      fhir:status [ fhir:v "active"] ; #
      fhir:type [
        ( fhir:coding [
    fhir:system [
    fhir:v "http://terminology.hl7.org/CodeSystem/claim-type"^^xsd:anyURI ;
    fhir:l <http://terminology.hl7.org/CodeSystem/claim-type>       ] ;
    fhir:code [ fhir:v "pharmacy" ] ;
    fhir:display [ fhir:v "Pharmacy" ]     ] )
      ] ; #
      fhir:use [ fhir:v "predetermination"] ; #
      fhir:patient [
    fhir:l fhir:Patient/rtpbc-patient-03ps ;
    fhir:reference [ fhir:v "Patient/rtpbc-patient-03ps" ]
      ] ; #
      fhir:created [ fhir:v "2019-11-01T11:20:59-05:00"^^xsd:dateTime] ; #
      fhir:insurer [
    fhir:identifier [
    fhir:value [ fhir:v "GoodPricing" ]     ]
      ] ; #
      fhir:request [
    fhir:identifier [
    fhir:value [ fhir:v "rtpbc-03" ]     ]
      ] ; #
      fhir:outcome [ fhir:v "complete"] ; #
      fhir:disposition [ fhir:v "Processed successfully"] ; #
      fhir:item ( [
    fhir:itemSequence [ fhir:v "1"^^xsd:positiveInteger ] ;
        ( fhir:noteNumber [ fhir:v "1"^^xsd:positiveInteger ] ) ;
        ( fhir:adjudication [
    fhir:category [
            ( fhir:coding [
    fhir:system [
    fhir:v "http://hl7.org/fhir/us/carin-rtpbc/CodeSystem/rtpbc-patient-pay-type"^^xsd:anyURI ;
    fhir:l <http://hl7.org/fhir/us/carin-rtpbc/CodeSystem/rtpbc-patient-pay-type>           ] ;
    fhir:code [ fhir:v "cash-price" ] ;
    fhir:display [ fhir:v "Full product cash price" ]         ] )       ] ;
    fhir:amount [
    fhir:value [ fhir:v "105"^^xsd:decimal ] ;
    fhir:currency [ fhir:v "USD" ]       ]     ] [
    fhir:category [
            ( fhir:coding [
    fhir:system [
    fhir:v "http://hl7.org/fhir/us/carin-rtpbc/CodeSystem/rtpbc-patient-pay-type"^^xsd:anyURI ;
    fhir:l <http://hl7.org/fhir/us/carin-rtpbc/CodeSystem/rtpbc-patient-pay-type>           ] ;
    fhir:code [ fhir:v "coupon-discount" ] ;
    fhir:display [ fhir:v "Coupon discount amount" ]         ] )       ] ;
    fhir:amount [
    fhir:value [ fhir:v "-20"^^xsd:decimal ] ;
    fhir:currency [ fhir:v "USD" ]       ]     ] [
    fhir:category [
            ( fhir:coding [
    fhir:system [
    fhir:v "http://hl7.org/fhir/us/carin-rtpbc/CodeSystem/rtpbc-patient-pay-type"^^xsd:anyURI ;
    fhir:l <http://hl7.org/fhir/us/carin-rtpbc/CodeSystem/rtpbc-patient-pay-type>           ] ;
    fhir:code [ fhir:v "total" ] ;
    fhir:display [ fhir:v "Total patient responsibility" ]         ] )       ] ;
    fhir:amount [
    fhir:value [ fhir:v "85"^^xsd:decimal ] ;
    fhir:currency [ fhir:v "USD" ]       ]     ] )
      ] ) ; #
      fhir:addItem ( [
        ( fhir:extension [
    fhir:url [
    fhir:v "http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-isAlternative"^^xsd:anyURI ;
    fhir:l <http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-isAlternative>       ] ;
    fhir:value [
    a fhir:Boolean ;
    fhir:v true       ]     ] ) ;
        ( fhir:itemSequence [ fhir:v "1"^^xsd:positiveInteger ] ) ;
        ( fhir:provider [
    fhir:l fhir:Organization/rtpbc-organization-03ps ;
    fhir:reference [ fhir:v "Organization/rtpbc-organization-03ps" ]     ] ) ;
    fhir:productOrService [
          ( fhir:coding [
    fhir:system [
    fhir:v "http://www.nlm.nih.gov/research/umls/rxnorm"^^xsd:anyURI ;
    fhir:l <http://www.nlm.nih.gov/research/umls/rxnorm>         ] ;
    fhir:code [ fhir:v "205535" ] ;
    fhir:display [ fhir:v "fluoxetine 10 MG Oral Capsule [Prozac]" ]       ] )     ] ;
    fhir:quantity [
    fhir:value [ fhir:v "60"^^xsd:decimal ] ;
    fhir:unit [ fhir:v "{Each}" ]     ] ;
        ( fhir:adjudication [
    fhir:category [
            ( fhir:coding [
    fhir:system [
    fhir:v "http://hl7.org/fhir/us/carin-rtpbc/CodeSystem/rtpbc-patient-pay-type"^^xsd:anyURI ;
    fhir:l <http://hl7.org/fhir/us/carin-rtpbc/CodeSystem/rtpbc-patient-pay-type>           ] ;
    fhir:code [ fhir:v "cash-price" ] ;
    fhir:display [ fhir:v "Full product cash price" ]         ] )       ] ;
    fhir:amount [
    fhir:value [ fhir:v "50"^^xsd:decimal ] ;
    fhir:currency [ fhir:v "USD" ]       ]     ] [
    fhir:category [
            ( fhir:coding [
    fhir:system [
    fhir:v "http://hl7.org/fhir/us/carin-rtpbc/CodeSystem/rtpbc-patient-pay-type"^^xsd:anyURI ;
    fhir:l <http://hl7.org/fhir/us/carin-rtpbc/CodeSystem/rtpbc-patient-pay-type>           ] ;
    fhir:code [ fhir:v "coupon-discount" ] ;
    fhir:display [ fhir:v "Coupon discount amount" ]         ] )       ] ;
    fhir:amount [
    fhir:value [ fhir:v "-10"^^xsd:decimal ] ;
    fhir:currency [ fhir:v "USD" ]       ]     ] [
    fhir:category [
            ( fhir:coding [
    fhir:system [
    fhir:v "http://hl7.org/fhir/us/carin-rtpbc/CodeSystem/rtpbc-patient-pay-type"^^xsd:anyURI ;
    fhir:l <http://hl7.org/fhir/us/carin-rtpbc/CodeSystem/rtpbc-patient-pay-type>           ] ;
    fhir:code [ fhir:v "total" ] ;
    fhir:display [ fhir:v "Total patient responsibility" ]         ] )       ] ;
    fhir:amount [
    fhir:value [ fhir:v "40"^^xsd:decimal ] ;
    fhir:currency [ fhir:v "USD" ]       ]     ] )
      ] ) . #