Consumer Real-Time Pharmacy Benefit Check FHIR IG
2.0.0 - CI Build United States of America flag

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-03wh

Format(s):

Narrative view

identifier: rtpbc-03-response

status: Active

type: Pharmacy

use: Predetermination

patient: Jane Doe Female, DoB: 1975-12-05 ( Patient internal identifier: 30455)

created: 2019-11-01 11:20:59-0500

insurer: Identifier: Pharmacy Plans US

request: Identifier: rtpbc-03

outcome: Processing Complete

disposition: Processed successfully

item

RTPBC benefitRestriction Extension: RTPBC Benefit Restriction Code System prior-auth: Prior authorization required

itemSequence: 1

adjudication

category: Copay

Amounts

-ValueCurrency
*40United States dollar

adjudication

category: Per prescription coinsurance

Amounts

-ValueCurrency
*30United States dollar

adjudication

category: Total patient responsibility

Amounts

-ValueCurrency
*70United States dollar

addItem

RTPBC isAlternative Extension: true

RTPBC benefitRestriction Extension: RTPBC Benefit Restriction Code System covered: Covered

itemSequence: 1

provider: Organization My Mail Service Pharmacy

productOrService: PROzac 10 MG Oral Capsule

quantity: 180 {Each}

adjudication

category: Copay

Amounts

-ValueCurrency
*20United States dollar

adjudication

category: Per prescription coinsurance

Amounts

-ValueCurrency
*30United States dollar

adjudication

category: Total patient responsibility

Amounts

-ValueCurrency
*50United States dollar