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
Page standards status: Informative |
@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:link <http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-response-claimresponse> ] )
] ; #
fhir:text [
fhir:status [ fhir:v "extensions" ] ;
fhir:div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><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: 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}\">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>"^^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:code [ fhir:v "pharmacy" ] ;
fhir:display [ fhir:v "Pharmacy" ] ] )
] ; #
fhir:use [ fhir:v "predetermination"] ; #
fhir:patient [
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: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: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: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:value [
a fhir:boolean ;
fhir:v true ] ] ) ;
( fhir:itemSequence [ fhir:v "1"^^xsd:positiveInteger ] ) ;
( fhir:provider [
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:code [ fhir:v "205535" ] ;
fhir:display [ fhir:v "PROzac 10 MG Oral Capsule" ] ] ) ] ;
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: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: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: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" ] ] ] )
] ) . #
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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