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-price-source",
"meta" : {
"profile" : [
🔗 "http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-response-bundle"
]
},
"type" : "message",
"timestamp" : "2019-11-15T13:10:15-05:00",
"entry" : [
{
"fullUrl" : "http://example.org/my-app/MessageHeader/rtpbc-messageheader-response-03ps",
"resource" : {
"resourceType" : "MessageHeader",
"id" : "rtpbc-messageheader-response-03ps",
"meta" : {
"profile" : [
🔗 "http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-response-messageheader"
]
},
"text" : {
"status" : "generated",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"MessageHeader_rtpbc-messageheader-response-03ps\"> </a><p class=\"res-header-id\"><b>Generated Narrative: MessageHeader rtpbc-messageheader-response-03ps</b></p><a name=\"rtpbc-messageheader-response-03ps\"> </a><a name=\"hcrtpbc-messageheader-response-03ps\"> </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>GoodPricing</td><td><a href=\"http://example.org/GoodPricing/fhir\">http://example.org/GoodPricing/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-price-source.html#http-//example.org/my-app/ClaimResponse/rtpbc-claim-response-03-price-source\">Bundle: type = message; timestamp = 2019-11-15 13:10:15-0500</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" : "GoodPricing",
"endpoint" : "http://example.org/GoodPricing/fhir"
},
"response" : {
"identifier" : "rtpbc-messageheader-request-03",
"code" : "ok"
},
"focus" : [
{
"reference" : "http://example.org/my-app/ClaimResponse/rtpbc-claim-response-03-price-source"
}
],
"definition" : "http://hl7.org/fhir/us/carin-rtpbc/MessageDefinition/rtpbc-response"
}
},
{
"fullUrl" : "http://example.org/my-app/ClaimResponse/rtpbc-claim-response-03-price-source",
"resource" : {
"resourceType" : "ClaimResponse",
"id" : "rtpbc-claim-response-03-price-source",
"meta" : {
"profile" : [
🔗 "http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-response-claimresponse"
]
},
"text" : {
"status" : "extensions",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"ClaimResponse_rtpbc-claim-response-03-price-source\"> </a><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\"/><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:\u00a030455)</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}\">PROzac 10 MG Oral Capsule</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>"
},
"identifier" : [
{
"value" : "rtpbc-03-response-price-source"
}
],
"status" : "active",
"type" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/claim-type",
"code" : "pharmacy",
"display" : "Pharmacy"
}
]
},
"use" : "predetermination",
"patient" : {
🔗 "reference" : "Patient/rtpbc-patient-03ps"
},
"created" : "2019-11-01T11:20:59-05:00",
"insurer" : {
"identifier" : {
"value" : "GoodPricing"
}
},
"request" : {
"identifier" : {
"value" : "rtpbc-03"
}
},
"outcome" : "complete",
"disposition" : "Processed successfully",
"item" : [
{
"itemSequence" : 1,
"noteNumber" : [
1
],
"adjudication" : [
{
"category" : {
"coding" : [
{
"system" : "http://hl7.org/fhir/us/carin-rtpbc/CodeSystem/rtpbc-patient-pay-type",
"code" : "cash-price",
"display" : "Full product cash price"
}
]
},
"amount" : {
"value" : 105,
"currency" : "USD"
}
},
{
"category" : {
"coding" : [
{
"system" : "http://hl7.org/fhir/us/carin-rtpbc/CodeSystem/rtpbc-patient-pay-type",
"code" : "coupon-discount",
"display" : "Coupon discount amount"
}
]
},
"amount" : {
"value" : -20,
"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" : 85,
"currency" : "USD"
}
}
]
}
],
"addItem" : [
{
"extension" : [
{
"url" : "http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-isAlternative",
"valueBoolean" : true
}
],
"itemSequence" : [
1
],
"provider" : [
{
🔗 "reference" : "Organization/rtpbc-organization-03ps"
}
],
"productOrService" : {
"coding" : [
{
"system" : "http://www.nlm.nih.gov/research/umls/rxnorm",
"code" : "205535",
"display" : "PROzac 10 MG Oral Capsule"
}
]
},
"quantity" : {
"value" : 60,
"unit" : "{Each}"
},
"adjudication" : [
{
"category" : {
"coding" : [
{
"system" : "http://hl7.org/fhir/us/carin-rtpbc/CodeSystem/rtpbc-patient-pay-type",
"code" : "cash-price",
"display" : "Full product cash price"
}
]
},
"amount" : {
"value" : 50,
"currency" : "USD"
}
},
{
"category" : {
"coding" : [
{
"system" : "http://hl7.org/fhir/us/carin-rtpbc/CodeSystem/rtpbc-patient-pay-type",
"code" : "coupon-discount",
"display" : "Coupon discount amount"
}
]
},
"amount" : {
"value" : -10,
"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" : 40,
"currency" : "USD"
}
}
]
}
]
}
},
{
"fullUrl" : "http://example.org/my-app/Patient/rtpbc-patient-03ps",
"resource" : {
"resourceType" : "Patient",
"id" : "rtpbc-patient-03ps",
"meta" : {
"profile" : [
🔗 "http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-patient"
]
},
"text" : {
"status" : "generated",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"Patient_rtpbc-patient-03ps\"> </a><p class=\"res-header-id\"><b>Generated Narrative: Patient rtpbc-patient-03ps</b></p><a name=\"rtpbc-patient-03ps\"> </a><a name=\"hcrtpbc-patient-03ps\"> </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/></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"
}
},
{
"fullUrl" : "http://example.org/my-app/Organization/rtpbc-organization-03ps",
"resource" : {
"resourceType" : "Organization",
"id" : "rtpbc-organization-03ps",
"meta" : {
"profile" : [
🔗 "http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-pharmacy-organization"
]
},
"text" : {
"status" : "generated",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"Organization_rtpbc-organization-03ps\"> </a><p class=\"res-header-id\"><b>Generated Narrative: Organization rtpbc-organization-03ps</b></p><a name=\"rtpbc-organization-03ps\"> </a><a name=\"hcrtpbc-organization-03ps\"> </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/6.5.0/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>/0999123</p><p><b>active</b>: true</p><p><b>type</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/NCPDPPharmacyType R}\">Retail</span></p><p><b>name</b>: Home Drugs</p><p><b>telecom</b>: ph: 5556057672</p><p><b>address</b>: 101 1st St N Minneapolis MN 55401 </p></div>"
},
"identifier" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/NCPDPProviderIdentificationNumber",
"value" : "0999123"
}
],
"active" : true,
"type" : [
{
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/NCPDPPharmacyType",
"code" : "R",
"display" : "Retail"
}
]
}
],
"name" : "Home Drugs",
"telecom" : [
{
"system" : "phone",
"value" : "5556057672"
}
],
"address" : [
{
"line" : [
"101 1st St N"
],
"city" : "Minneapolis",
"state" : "MN",
"postalCode" : "55401"
}
]
}
}
]
}
IG © 2024+ HL7 International / Pharmacy. Package hl7.fhir.us.carin-rtpbc#2.0.0 based on FHIR 4.0.1. Generated 2025-08-07
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