# rtpbc-claim-non-phi-2 - Consumer Real-Time Pharmacy Benefit Check FHIR IG v2.0.0-ballot

## Example Claim: rtpbc-claim-non-phi-2

Language: en

Profile: [RTPBC Request Using Claim - Non-PHI](StructureDefinition-rtpbc-request-claim-non-phi.md)

**identifier**: rtpbc-claim-non-phi-2

**status**: Active

**type**: Pharmacy

**use**: Predetermination

**patient**: ?rref?

**created**: 2025-11-01 11:20:54-0500

**provider**: [Organization Hometown Drug](Organization-rtpbc-organization-01.md)

**priority**: Normal

### Insurances

| | | | |
| :--- | :--- | :--- | :--- |
| - | **Sequence** | **Focal** | **Coverage** |
| * | 1 | false | ?rref? |

### Items

| | | | |
| :--- | :--- | :--- | :--- |
| - | **Sequence** | **ProductOrService** | **Quantity** |
| * | 1 | Prozac 10mg Capsule | 60 {Each} |



## Resource Content

```json
{
  "resourceType" : "Claim",
  "id" : "rtpbc-claim-non-phi-2",
  "meta" : {
    "profile" : ["http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-request-claim-non-phi"]
  },
  "language" : "en",
  "identifier" : [{
    "value" : "rtpbc-claim-non-phi-2"
  }],
  "status" : "active",
  "type" : {
    "coding" : [{
      "system" : "http://terminology.hl7.org/CodeSystem/claim-type",
      "code" : "pharmacy",
      "display" : "Pharmacy"
    }]
  },
  "use" : "predetermination",
  "patient" : {
    "extension" : [{
      "url" : "http://hl7.org/fhir/StructureDefinition/data-absent-reason",
      "valueCode" : "masked"
    }]
  },
  "created" : "2025-11-01T11:20:54-05:00",
  "provider" : {
    "reference" : "Organization/rtpbc-organization-01"
  },
  "priority" : {
    "coding" : [{
      "system" : "http://terminology.hl7.org/CodeSystem/processpriority",
      "code" : "normal",
      "display" : "Normal"
    }]
  },
  "insurance" : [{
    "sequence" : 1,
    "focal" : false,
    "coverage" : {
      "extension" : [{
        "url" : "http://hl7.org/fhir/StructureDefinition/data-absent-reason",
        "valueCode" : "masked"
      }]
    }
  }],
  "item" : [{
    "sequence" : 1,
    "productOrService" : {
      "coding" : [{
        "system" : "http://www.nlm.nih.gov/research/umls/rxnorm",
        "code" : "205535",
        "display" : "fluoxetine 10 MG Oral Capsule [Prozac]"
      }],
      "text" : "Prozac 10mg Capsule"
    },
    "quantity" : {
      "value" : 60,
      "unit" : "{Each}"
    }
  }]
}

```
