The UCUM codes, UCUM table (regardless of format), and UCUM Specification are copyright 1999-2009, Regenstrief Institute, Inc. and the Unified Codes for Units of Measures (UCUM) Organization. All rights reserved. https://ucum.org/trac/wiki/TermsOfUse
Using RxNorm codes of type SAB=RXNORM as this specification describes does not require a UMLS license. Access to the full set of RxNorm definitions, and/or additional use of other RxNorm structures and information requires a UMLS license. The use of RxNorm in this specification is pursuant to HL7's status as a licensee of the NLM UMLS. HL7's license does not convey the right to use RxNorm to any users of this specification; implementers must acquire a license to use RxNorm in their own right.
Consumer RTPBC leverages the predetermination process supported by the Claim and ClaimResponse FHIR® resources. Accompanying resources carry information that identifies the patient and their insurance coverage, prescription information and the preferred pharmacy (Patient, Coverage, MedicationRequest, Practitioner and Organization). OperationOutcome is used to communicate exceptions. ( src
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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 ( src
)
Like the option above, the $process-message operation takes a single FHIR® resource input parameter consisting of a Bundle containing the Claim resource and referenced supporting resources, and returns a Bundle containing a ClaimResponse and supporting resources. ( src
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The consumer RTPBC request and response are accomplished using FHIR Claim and ClaimResponse resources in a "predetermination" (what-if) mode. Other FHIR® resources support the exchange by fleshing out patient, prescription, pharmacy and coverage information needed to determine accurate cost and coverage. An OperationOutcome communicates exception situations where a ClaimResponse cannot be returned. ( src
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There are examples where a medication request may include the option of an oral dose or an Intravenous or Intramuscular dose. For example, "Ondansetron 8mg orally or IV twice a day as needed for nausea" or "Compazine® (prochlorperazine) 5-10mg PO or 25mg PR bid prn nausea or vomiting". In these cases, two medication requests would be created that could be grouped together. The decision on which dose and route of administration to use is based on the patient's condition at the time the dose is needed. ( src
)
This is a guide for implementing a consumer-focused Real-time Pharmacy Benefit Check (RTPBC) process using HL7 FHIR® R4. ( src
)
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
Details on determining an appropriate representative NDC 11 are available in the SCRIPT Implementation Recommendations
document, located on the public ePrescribing site of the National Council for Prescription Drug Programs (NCPDP).
The UCUM codes, UCUM table (regardless of format), and UCUM Specification are copyright 1999-2009, Regenstrief Institute, Inc. and the Unified Codes for Units of Measures (UCUM) Organization. All rights reserved. https://ucum.org/trac/wiki/TermsOfUse
