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

## : rtpbc-bundle-response-price-source

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    {
      "resourceType" : "Bundle",
      "id" : "rtpbc-bundle-response-price-source",
      "meta" : {
        "profile" : [
          🔗 "http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-response-bundle-non-phi"
        ]
      },
      "language" : "en",
      "type" : "message",
      "timestamp" : "2025-11-15T13:10:13-05:00",
      "entry" : [
        {
          "fullUrl" : "http://example.org/my-app/MessageHeader/rtpbc-messageheader-response-price-source",
          "resource" : {
            "resourceType" : "MessageHeader",
            "id" : "rtpbc-messageheader-response-price-source",
            "meta" : {
              "profile" : [
                🔗 "http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-response-messageheader-non-phi"
              ]
            },
            "language" : "en",
            "text" : {
              "status" : "generated",
              "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"MessageHeader_rtpbc-messageheader-response-price-source\"> </a><p class=\"res-header-id\"><b>Generated Narrative: MessageHeader rtpbc-messageheader-response-price-source</b></p><a name=\"rtpbc-messageheader-response-price-source\"> </a><a name=\"hcrtpbc-messageheader-response-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-messageheader-non-phi.html\">RTPBC Non-PHI Response MessageHeader</a></p></div><p><b>event</b>: <a href=\"CodeSystem-rtpbc-event-type.html#rtpbc-event-type-rtpbc-response-non-phi\">RTPBC Event Type Code System: rtpbc-response-non-phi</a> (RTPBC Non-PHI Response)</p><h3>Sources</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Name</b></td><td><b>Endpoint</b></td></tr><tr><td style=\"display: none\">*</td><td>GoodPricing</td><td><a href=\"http://example.org/GoodPricing/fhir\">http://example.org/GoodPricing/fhir</a></td></tr></table><h3>Responses</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Identifier</b></td><td><b>Code</b></td></tr><tr><td style=\"display: none\">*</td><td>rtpbc-messageheader-request-non-phi-1</td><td>OK</td></tr></table><p><b>focus</b>: <a href=\"Bundle-rtpbc-bundle-response-price-source.html#http-//example.org/my-app/ClaimResponse/rtpbc-claim-response-price-source\">ClaimResponse: identifier = rtpbc-response-price-source; status = active; type = Pharmacy; use = predetermination; created = 2025-11-15 13:10:13-0500; outcome = complete; disposition = Processed successfully</a></p><p><b>definition</b>: <a href=\"MessageDefinition-rtpbc-response-non-phi.html\">RTPBC Non-PHI Response Message Definition</a></p></div>"
            },
            "eventCoding" : {
              "system" : "http://hl7.org/fhir/us/carin-rtpbc/CodeSystem/rtpbc-event-type",
              "code" : "rtpbc-response-non-phi",
              "display" : "RTPBC Non-PHI Response"
            },
            "source" : {
              "name" : "GoodPricing",
              "endpoint" : "http://example.org/GoodPricing/fhir"
            },
            "response" : {
              "identifier" : "rtpbc-messageheader-request-non-phi-1",
              "code" : "ok"
            },
            "focus" : [
              {
                "reference" : "http://example.org/my-app/ClaimResponse/rtpbc-claim-response-price-source"
              }
            ],
            "definition" : "http://hl7.org/fhir/us/carin-rtpbc/MessageDefinition/rtpbc-response-non-phi"
          }
        },
        {
          "fullUrl" : "http://example.org/my-app/ClaimResponse/rtpbc-claim-response-price-source",
          "resource" : {
            "resourceType" : "ClaimResponse",
            "id" : "rtpbc-claim-response-price-source",
            "meta" : {
              "profile" : [
                🔗 "http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-response-claimresponse-non-phi"
              ]
            },
            "language" : "en",
            "text" : {
              "status" : "extensions",
              "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"ClaimResponse_rtpbc-claim-response-price-source\"> </a><p class=\"res-header-id\"><b>Generated Narrative: ClaimResponse rtpbc-claim-response-price-source</b></p><a name=\"rtpbc-claim-response-price-source\"> </a><a name=\"hcrtpbc-claim-response-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-non-phi.html\">RTPBC Non-PHI Response Using ClaimResponse</a></p></div><p><b>identifier</b>: rtpbc-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>: ?rref?</p><p><b>created</b>: 2025-11-15 13:10:13-0500</p><p><b>insurer</b>: ?rref?</p><p><b>request</b>: Identifier: rtpbc-01</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-temporary 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-temporary 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-temporary 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>productOrService</b>: <span title=\"Codes:{http://www.nlm.nih.gov/research/umls/rxnorm 205535}\">fluoxetine 10 MG Oral Capsule [Prozac]</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-temporary 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-temporary 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-temporary 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>"
            },
            "identifier" : [
              {
                "value" : "rtpbc-response-price-source"
              }
            ],
            "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" : "2025-11-15T13:10:13-05:00",
            "insurer" : {
              "extension" : [
                {
                  "url" : "http://hl7.org/fhir/StructureDefinition/data-absent-reason",
                  "valueCode" : "masked"
                }
              ]
            },
            "request" : {
              "identifier" : {
                "value" : "rtpbc-01"
              }
            },
            "outcome" : "complete",
            "disposition" : "Processed successfully",
            "item" : [
              {
                "itemSequence" : 1,
                "noteNumber" : [
                  1
                ],
                "adjudication" : [
                  {
                    "category" : {
                      "coding" : [
                        {
                          "system" : "http://hl7.org/fhir/us/carin-rtpbc/CodeSystem/rtpbc-patient-pay-type-temporary",
                          "code" : "cash-price",
                          "display" : "Full product cash price"
                        }
                      ]
                    },
                    "amount" : {
                      "value" : 105,
                      "currency" : "USD"
                    }
                  },
                  {
                    "category" : {
                      "coding" : [
                        {
                          "system" : "http://hl7.org/fhir/us/carin-rtpbc/CodeSystem/rtpbc-patient-pay-type-temporary",
                          "code" : "coupon-discount",
                          "display" : "Coupon discount amount"
                        }
                      ]
                    },
                    "amount" : {
                      "value" : -20,
                      "currency" : "USD"
                    }
                  },
                  {
                    "category" : {
                      "coding" : [
                        {
                          "system" : "http://hl7.org/fhir/us/carin-rtpbc/CodeSystem/rtpbc-patient-pay-type-temporary",
                          "code" : "total",
                          "display" : "Total patient responsibility"
                        }
                      ]
                    },
                    "amount" : {
                      "value" : 85,
                      "currency" : "USD"
                    }
                  }
                ]
              }
            ],
            "addItem" : [
              {
                "extension" : [
                  {
                    "url" : "http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-isAlternative",
                    "valueBoolean" : true
                  }
                ],
                "itemSequence" : [
                  1
                ],
                "productOrService" : {
                  "coding" : [
                    {
                      "system" : "http://www.nlm.nih.gov/research/umls/rxnorm",
                      "code" : "205535",
                      "display" : "fluoxetine 10 MG Oral Capsule [Prozac]"
                    }
                  ]
                },
                "quantity" : {
                  "value" : 60,
                  "unit" : "{Each}"
                },
                "adjudication" : [
                  {
                    "category" : {
                      "coding" : [
                        {
                          "system" : "http://hl7.org/fhir/us/carin-rtpbc/CodeSystem/rtpbc-patient-pay-type-temporary",
                          "code" : "cash-price",
                          "display" : "Full product cash price"
                        }
                      ]
                    },
                    "amount" : {
                      "value" : 50,
                      "currency" : "USD"
                    }
                  },
                  {
                    "category" : {
                      "coding" : [
                        {
                          "system" : "http://hl7.org/fhir/us/carin-rtpbc/CodeSystem/rtpbc-patient-pay-type-temporary",
                          "code" : "coupon-discount",
                          "display" : "Coupon discount amount"
                        }
                      ]
                    },
                    "amount" : {
                      "value" : -10,
                      "currency" : "USD"
                    }
                  },
                  {
                    "category" : {
                      "coding" : [
                        {
                          "system" : "http://hl7.org/fhir/us/carin-rtpbc/CodeSystem/rtpbc-patient-pay-type-temporary",
                          "code" : "total",
                          "display" : "Total patient responsibility"
                        }
                      ]
                    },
                    "amount" : {
                      "value" : 40,
                      "currency" : "USD"
                    }
                  }
                ]
              }
            ]
          }
        }
      ]
    }