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-w-header",
"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-03wh",
"resource" : {
"resourceType" : "MessageHeader",
"id" : "rtpbc-messageheader-response-03wh",
"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-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-w-header.html#http-//example.org/my-app/ClaimResponse/rtpbc-claim-response-03wh\">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" : "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"
]
},
"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-03wh.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-03wh.html\">Organization My Mail Service Pharmacy</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>: 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-03wh"
},
"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-03wh"
}
],
"productOrService" : {
"coding" : [
{
"system" : "http://www.nlm.nih.gov/research/umls/rxnorm",
"code" : "205535",
"display" : "PROzac 10 MG Oral Capsule"
}
]
},
"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-03wh",
"resource" : {
"resourceType" : "Patient",
"id" : "rtpbc-patient-03wh",
"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-03wh\"> </a><p class=\"res-header-id\"><b>Generated Narrative: Patient rtpbc-patient-03wh</b></p><a name=\"rtpbc-patient-03wh\"> </a><a name=\"hcrtpbc-patient-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-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-03wh",
"resource" : {
"resourceType" : "Organization",
"id" : "rtpbc-organization-03wh",
"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-03wh\"> </a><p class=\"res-header-id\"><b>Generated Narrative: Organization rtpbc-organization-03wh</b></p><a name=\"rtpbc-organization-03wh\"> </a><a name=\"hcrtpbc-organization-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-pharmacy-organization.html\">RTPBC Pharmacy Organization</a></p></div><p><b>identifier</b>: <a href=\"http://terminology.hl7.org/6.5.0/NamingSystem-npi.html\" title=\"National Provider Identifier\">United States National Provider Identifier</a>/5515515515</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://hl7.org/fhir/sid/us-npi",
"value" : "5515515515"
}
],
"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 2025-08-07
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