Consumer Real-Time Pharmacy Benefit Check FHIR IG
2.0.0-ballot - STU 2 Ballot

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-ballot 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

## Resource Profile: RTPBC Non-PHI Response Using ClaimResponse - Mappings

Page standards status: Trial-use | Maturity Level: 2

Mappings for the rtpbc-response-claimresponse-non-phi resource profile.

#### Mappings to Structures in this Implementation Guide

No Mappings Found

#### Mappings to other Structures

No Mappings Found

#### Other Mappings

Name | Workflow Pattern | FiveWs Pattern Mapping | RIM Mapping
--- | --- | --- | ---
ClaimResponse | Event |  | Entity. Role or Act
id |  |  |
meta |  |  |
implicitRules |  |  |
language |  |  |
text |  |  | Act.text?
contained |  |  | N/A
extension |  |  | N/A
modifierExtension |  |  | N/A
identifier | Event.identifier | FiveWs.identifier |
id |  |  | n/a
extension |  |  | n/a
use |  |  | Role.code or implied by context
type |  |  | Role.code or implied by context
system |  |  | II.root or Role.id.root
value |  |  | II.extension or II.root if system indicates OID or GUID (Or Role.id.extension or root)
period |  |  | Role.effectiveTime or implied by context
assigner |  |  | II.assigningAuthorityName but note that this is an improper use by the definition of the field. Also Role.scoper
status | Event.status | FiveWs.status |
type |  | FiveWs.class |
id |  |  | n/a
extension |  |  | n/a
coding |  |  | union(. ./translation)
id |  |  | n/a
extension |  |  | n/a
system |  |  | ./codeSystem
version |  |  | ./codeSystemVersion
code |  |  | ./code
display |  |  | CV.displayName
userSelected |  |  | CD.codingRationale
text |  |  | ./originalText[mediaType/code="text/plain"]/data
subType |  | FiveWs.class |
use |  | FiveWs.class |
patient |  | FiveWs.subject |
id |  |  | n/a
Slices for extension |  |  |
extension:data-masked |  |  | ANY.nullFlavor
id |  |  | n/a
extension |  |  |
url |  |  | N/A
value[x] |  |  | N/A
reference |  |  | N/A
type |  |  | N/A
identifier |  |  | .identifier
display |  |  | N/A
created | Event.occurrence[x] | FiveWs.recorded |
insurer | Event.performer |  |
id |  |  | n/a
Slices for extension |  |  |
extension:data-masked |  |  | ANY.nullFlavor
id |  |  | n/a
extension |  |  |
url |  |  | N/A
value[x] |  |  | N/A
reference |  |  | N/A
type |  |  | N/A
identifier |  |  | .identifier
display |  |  | N/A
requestor |  | FiveWs.source |
request | Event.basedOn | FiveWs.why[x] |
id |  |  | n/a
extension |  |  | n/a
reference |  |  | N/A
type |  |  | N/A
identifier |  |  | .identifier
id |  |  | n/a
extension |  |  | n/a
use |  |  | Role.code or implied by context
type |  |  | Role.code or implied by context
system |  |  | II.root or Role.id.root
value |  |  | II.extension or II.root if system indicates OID or GUID (Or Role.id.extension or root)
period |  |  | Role.effectiveTime or implied by context
assigner |  |  | II.assigningAuthorityName but note that this is an improper use by the definition of the field. Also Role.scoper
display |  |  | N/A
outcome |  |  |
disposition | Event.note |  |
preAuthRef |  |  |
preAuthPeriod |  |  |
payeeType |  |  |
item |  |  |
id |  |  | n/a
Slices for extension |  |  |
extension:benefitRestriction |  |  |
extension:formularyStatus |  |  |
extension:preferenceLevel |  |  |
extension:nextAvailableFillDate |  |  |
extension:relatedCoverage |  |  |
modifierExtension |  |  | N/A
itemSequence |  |  |
noteNumber |  |  |
adjudication |  |  |
id |  |  | n/a
extension |  |  | n/a
modifierExtension |  |  | N/A
category |  |  |
reason |  |  |
amount |  |  |
id |  |  | n/a
extension |  |  | n/a
value |  |  |
currency |  |  |
value |  |  |
detail |  |  |
id |  |  | n/a
extension |  |  | n/a
modifierExtension |  |  | N/A
detailSequence |  |  |
noteNumber |  |  |
adjudication |  |  |
subDetail |  |  |
id |  |  | n/a
extension |  |  | n/a
modifierExtension |  |  | N/A
subDetailSequence |  |  |
noteNumber |  |  |
adjudication |  |  |
addItem |  |  |
id |  |  | n/a
Slices for extension |  |  |
extension:isAlternative |  |  |
extension:benefitRestriction |  |  |
extension:formularyStatus |  |  |
extension:preferenceLevel |  |  |
extension:nextAvailableFillDate |  |  |
extension:relatedCoverage |  |  |
modifierExtension |  |  | N/A
itemSequence |  |  |
detailSequence |  |  |
subdetailSequence |  |  |
provider |  | FiveWs.source |
id |  |  | n/a
extension |  |  | n/a
reference |  |  | N/A
type |  |  | N/A
identifier |  |  | .identifier
display |  |  | N/A
productOrService |  |  |
id |  |  | n/a
extension |  |  | n/a
coding |  |  | union(. ./translation)
id |  |  | n/a
extension |  |  | n/a
system |  |  | ./codeSystem
version |  |  | ./codeSystemVersion
code |  |  | ./code
display |  |  | CV.displayName
userSelected |  |  | CD.codingRationale
text |  |  | ./originalText[mediaType/code="text/plain"]/data
modifier |  |  | 24.C 24.D mods
programCode |  |  | 24.H
serviced[x] |  | FiveWs.done[x] | 24.A
location[x] |  | FiveWs.where[x] | 24.B
quantity |  |  | 24.G
id |  |  | n/a
extension |  |  | n/a
value |  |  | PQ.value CO.value MO.value IVL.high or IVL.low depending on the value
comparator |  |  | IVL properties
unit |  |  | PQ.unit
system |  |  | CO.codeSystem PQ.translation.codeSystem
code |  |  | PQ.code MO.currency PQ.translation.code
unitPrice |  |  |
factor |  |  |
net |  |  | 24.F
bodySite |  |  |
subSite |  |  |
noteNumber |  |  |
adjudication |  |  |
id |  |  | n/a
extension |  |  | n/a
modifierExtension |  |  | N/A
category |  |  |
reason |  |  |
amount |  |  |
id |  |  | n/a
extension |  |  | n/a
value |  |  |
currency |  |  |
value |  |  |
detail |  |  |
id |  |  | n/a
extension |  |  | n/a
modifierExtension |  |  | N/A
productOrService |  |  |
modifier |  |  | 24.C 24.D mods
quantity |  |  | 24.G
unitPrice |  |  |
factor |  |  |
net |  |  | 24.F
noteNumber |  |  |
adjudication |  |  |
subDetail |  |  |
id |  |  | n/a
extension |  |  | n/a
modifierExtension |  |  | N/A
productOrService |  |  |
modifier |  |  | 24.C 24.D mods
quantity |  |  | 24.G
unitPrice |  |  |
factor |  |  |
net |  |  | 24.F
noteNumber |  |  |
adjudication |  |  |
adjudication |  |  |
total |  |  |
id |  |  | n/a
extension |  |  | n/a
modifierExtension |  |  | N/A
category |  |  |
amount |  |  |
payment |  |  |
id |  |  | n/a
extension |  |  | n/a
modifierExtension |  |  | N/A
type |  |  |
adjustment |  |  |
adjustmentReason |  |  |
date |  |  |
amount |  |  |
identifier |  |  |
fundsReserve |  |  |
formCode |  |  |
form |  |  |
processNote |  |  |
id |  |  | n/a
extension |  |  | n/a
modifierExtension |  |  | N/A
number |  |  |
type |  |  |
text |  |  |
language |  |  |
communicationRequest |  |  |
insurance |  |  | Coverage
id |  |  | n/a
extension |  |  | n/a
modifierExtension |  |  | N/A
sequence |  |  |
focal |  |  |
coverage |  |  |
businessArrangement |  |  |
claimResponse |  |  |
error |  |  |
id |  |  | n/a
extension |  |  | n/a
modifierExtension |  |  | N/A
itemSequence |  |  |
detailSequence |  |  |
subDetailSequence |  |  |
code |  |  |
id |  |  | n/a
extension |  |  | n/a
coding |  |  | union(. ./translation)
id |  |  | n/a
extension |  |  | n/a
system |  |  | ./codeSystem
version |  |  | ./codeSystemVersion
code |  |  | ./code
display |  |  | CV.displayName
userSelected |  |  | CD.codingRationale
text |  |  | ./originalText[mediaType/code="text/plain"]/data
Documentation for this format