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 Patient Pay Type Code System - JSON Representation

Page standards status: Trial-use Maturity Level: 4

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{
  "resourceType" : "CodeSystem",
  "id" : "rtpbc-patient-pay-type",
  "meta" : {
    "lastUpdated" : "2019-12-08T00:00:00-05:00"
  },
  "text" : {
    "status" : "generated",
    "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p class=\"res-header-id\"><b>Generated Narrative: CodeSystem rtpbc-patient-pay-type</b></p><a name=\"rtpbc-patient-pay-type\"> </a><a name=\"hcrtpbc-patient-pay-type\"> </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\">Last updated: 2019-12-08 00:00:00-0500</p></div><p>This case-insensitive code system <code>http://hl7.org/fhir/us/carin-rtpbc/CodeSystem/rtpbc-patient-pay-type</code> defines the following codes:</p><table class=\"codes\"><tr><td style=\"white-space:nowrap\"><b>Code</b></td><td><b>Display</b></td><td><b>Definition</b></td></tr><tr><td style=\"white-space:nowrap\">deductible<a name=\"rtpbc-patient-pay-type-deductible\"> </a></td><td>Deductible</td><td>Amount to be collected from a patient to be applied to a periodic deductible</td></tr><tr><td style=\"white-space:nowrap\">coinsurance<a name=\"rtpbc-patient-pay-type-coinsurance\"> </a></td><td>Per prescription coinsurance</td><td>Amount to be collected from a patient to satisfy a per prescription coinsurance</td></tr><tr><td style=\"white-space:nowrap\">copay<a name=\"rtpbc-patient-pay-type-copay\"> </a></td><td>Copay</td><td>Amount to be collected from the patient to satisfy a per prescription copay</td></tr><tr><td style=\"white-space:nowrap\">tax<a name=\"rtpbc-patient-pay-type-tax\"> </a></td><td>Tax</td><td>Amount to be collected from the patient for sales tax</td></tr><tr><td style=\"white-space:nowrap\">cash-price<a name=\"rtpbc-patient-pay-type-cash-price\"> </a></td><td>Full product cash price</td><td>Full product cash price before discounts or coupons</td></tr><tr><td style=\"white-space:nowrap\">coupon-discount<a name=\"rtpbc-patient-pay-type-coupon-discount\"> </a></td><td>Coupon discount amount</td><td>Coupon discount reducing the amount to be collected from the patient</td></tr><tr><td style=\"white-space:nowrap\">member-discount<a name=\"rtpbc-patient-pay-type-member-discount\"> </a></td><td>Member discount amount</td><td>Member discount reducing the amount to be collected from the patient</td></tr><tr><td style=\"white-space:nowrap\">other-discount<a name=\"rtpbc-patient-pay-type-other-discount\"> </a></td><td>Other discount amount</td><td>Other discount reducing the amount to be collected from the patient</td></tr><tr><td style=\"white-space:nowrap\">other-cost<a name=\"rtpbc-patient-pay-type-other-cost\"> </a></td><td>Other cost</td><td>Other amount to be collected from the patient</td></tr><tr><td style=\"white-space:nowrap\">eligible<a name=\"rtpbc-patient-pay-type-eligible\"> </a></td><td>Eligible amount</td><td>Amount that is considered for adjudication</td></tr><tr><td style=\"white-space:nowrap\">total<a name=\"rtpbc-patient-pay-type-total\"> </a></td><td>Total patient responsibility</td><td>Amount equalling the total patient responsibility for a prescription product's cost</td></tr></table></div>"
  },
  "extension" : [
    {
      "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-wg",
      "valueCode" : "phx"
    },
    {
      "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-fmm",
      "valueInteger" : 4,
      "_valueInteger" : {
        "extension" : [
          {
            "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom",
            "valueCanonical" : "http://hl7.org/fhir/us/carin-rtpbc/ImplementationGuide/hl7.fhir.us.carin-rtpbc"
          }
        ]
      }
    },
    {
      "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
      "valueCode" : "trial-use",
      "_valueCode" : {
        "extension" : [
          {
            "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom",
            "valueCanonical" : "http://hl7.org/fhir/us/carin-rtpbc/ImplementationGuide/hl7.fhir.us.carin-rtpbc"
          }
        ]
      }
    }
  ],
  "url" : "http://hl7.org/fhir/us/carin-rtpbc/CodeSystem/rtpbc-patient-pay-type",
  "version" : "2.0.0",
  "name" : "RtpbcPatientPayTypeCodeSystem",
  "title" : "RTPBC Patient Pay Type Code System",
  "status" : "active",
  "experimental" : false,
  "date" : "2020-05-23T00:00:00-05:00",
  "publisher" : "HL7 International / Pharmacy",
  "contact" : [
    {
      "name" : "HL7 International / Pharmacy",
      "telecom" : [
        {
          "system" : "url",
          "value" : "http://www.hl7.org/Special/committees/medication"
        }
      ]
    },
    {
      "name" : "Frank McKinney",
      "telecom" : [
        {
          "system" : "email",
          "value" : "fm@frankmckinney.com"
        }
      ]
    }
  ],
  "description" : "This code system defines components of a patient's responsibility for a prescription product's cost.",
  "jurisdiction" : [
    {
      "coding" : [
        {
          "system" : "urn:iso:std:iso:3166",
          "code" : "US",
          "display" : "United States of America"
        }
      ]
    }
  ],
  "caseSensitive" : false,
  "content" : "complete",
  "count" : 11,
  "concept" : [
    {
      "code" : "deductible",
      "display" : "Deductible",
      "definition" : "Amount to be collected from a patient to be applied to a periodic deductible"
    },
    {
      "code" : "coinsurance",
      "display" : "Per prescription coinsurance",
      "definition" : "Amount to be collected from a patient to satisfy a per prescription coinsurance"
    },
    {
      "code" : "copay",
      "display" : "Copay",
      "definition" : "Amount to be collected from the patient to satisfy a per prescription copay"
    },
    {
      "code" : "tax",
      "display" : "Tax",
      "definition" : "Amount to be collected from the patient for sales tax"
    },
    {
      "code" : "cash-price",
      "display" : "Full product cash price",
      "definition" : "Full product cash price before discounts or coupons"
    },
    {
      "code" : "coupon-discount",
      "display" : "Coupon discount amount",
      "definition" : "Coupon discount reducing the amount to be collected from the patient"
    },
    {
      "code" : "member-discount",
      "display" : "Member discount amount",
      "definition" : "Member discount reducing the amount to be collected from the patient"
    },
    {
      "code" : "other-discount",
      "display" : "Other discount amount",
      "definition" : "Other discount reducing the amount to be collected from the patient"
    },
    {
      "code" : "other-cost",
      "display" : "Other cost",
      "definition" : "Other amount to be collected from the patient"
    },
    {
      "code" : "eligible",
      "display" : "Eligible amount",
      "definition" : "Amount that is considered for adjudication"
    },
    {
      "code" : "total",
      "display" : "Total patient responsibility",
      "definition" : "Amount equalling the total patient responsibility for a prescription product's cost"
    }
  ]
}