# RTPBC Coverage - Non-PHI - Consumer Real-Time Pharmacy Benefit Check FHIR IG v2.0.0-ballot

## Resource Profile: RTPBC Coverage - Non-PHI 

 
Coverage resource in which no personally-identifiable information is included. Used for representing non-patient-specific payment sources such as medication discount cards. 

This profile constrains the Coverage resource to contain non-patient-specific coverage information related to an RTPBC response entry conveyed in a Claim.item or Claim.addItem element.

Data population is based on the [RTPBC Coverage](StructureDefinition-rtpbc-coverage.md) but excludes content that could contain information about the patient.

### Masked information

The following element is unavailable in this profile:

* beneficiary

§PHI-COV-1:To conform with the Non-PHI Coverage profile, the Data Absent Reason extension **SHALL** be used in the Coverage.beneficiary element, populated with the code, "masked".§

**Usages:**

* Use this Profile: [RTPBC Response Bundle Non-PHI](StructureDefinition-rtpbc-response-bundle-non-phi.md)
* Refer to this Profile: [RTPBC relatedCoverage Extension](StructureDefinition-rtpbc-relatedCoverage.md)
* Examples for this Profile: [Coverage/rtpbc-coverage-non-phi-01](Coverage-rtpbc-coverage-non-phi-01.md)

You can also check for [usages in the FHIR IG Statistics](https://packages2.fhir.org/xig/hl7.fhir.us.carin-rtpbc|current/StructureDefinition/rtpbc-coverage-non-phi)

### Formal Views of Profile Content

 [Description Differentials, Snapshots, and other representations](http://build.fhir.org/ig/FHIR/ig-guidance/readingIgs.html#structure-definitions). 

 

Other representations of profile: [CSV](../StructureDefinition-rtpbc-coverage-non-phi.csv), [Excel](../StructureDefinition-rtpbc-coverage-non-phi.xlsx), [Schematron](../StructureDefinition-rtpbc-coverage-non-phi.sch) 



## Resource Content

```json
{
  "resourceType" : "StructureDefinition",
  "id" : "rtpbc-coverage-non-phi",
  "meta" : {
    "lastUpdated" : "2026-03-03T00:00:00-05:00"
  },
  "extension" : [{
    "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-wg",
    "valueCode" : "phx"
  },
  {
    "url" : "http://hl7.org/fhir/StructureDefinition/structuredefinition-fmm",
    "valueInteger" : 2,
    "_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/StructureDefinition/rtpbc-coverage-non-phi",
  "version" : "2.0.0-ballot",
  "name" : "RtpbcCoverageNonPHI",
  "title" : "RTPBC Coverage - Non-PHI",
  "status" : "active",
  "experimental" : false,
  "date" : "2026-03-03T00:00:00-05:00",
  "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" : "Coverage resource in which no personally-identifiable information is included. Used for representing non-patient-specific payment sources such as medication discount cards.",
  "jurisdiction" : [{
    "coding" : [{
      "system" : "urn:iso:std:iso:3166",
      "code" : "US",
      "display" : "United States of America"
    }]
  }],
  "fhirVersion" : "4.0.1",
  "mapping" : [{
    "identity" : "workflow",
    "uri" : "http://hl7.org/fhir/workflow",
    "name" : "Workflow Pattern"
  },
  {
    "identity" : "rim",
    "uri" : "http://hl7.org/v3",
    "name" : "RIM Mapping"
  },
  {
    "identity" : "w5",
    "uri" : "http://hl7.org/fhir/fivews",
    "name" : "FiveWs Pattern Mapping"
  },
  {
    "identity" : "cdanetv4",
    "uri" : "http://www.cda-adc.ca/en/services/cdanet/",
    "name" : "Canadian Dental Association eclaims standard"
  },
  {
    "identity" : "v2",
    "uri" : "http://hl7.org/v2",
    "name" : "HL7 v2 Mapping"
  },
  {
    "identity" : "cpha3pharm",
    "uri" : "http://www.pharmacists.ca/",
    "name" : "Canadian Pharmacy Associaiton eclaims standard"
  }],
  "kind" : "resource",
  "abstract" : false,
  "type" : "Coverage",
  "baseDefinition" : "http://hl7.org/fhir/us/core/StructureDefinition/us-core-coverage",
  "derivation" : "constraint",
  "differential" : {
    "element" : [{
      "id" : "Coverage",
      "path" : "Coverage"
    },
    {
      "id" : "Coverage.subscriberId",
      "path" : "Coverage.subscriberId",
      "label" : "Subscriber ID (masked)",
      "short" : "Subscriber ID (masked)",
      "definition" : "No personally-identifiable information is included in this profile. Instead, the patient element is populated with a Data Absent Reason = 'masked'"
    },
    {
      "id" : "Coverage.subscriberId.extension",
      "path" : "Coverage.subscriberId.extension",
      "slicing" : {
        "discriminator" : [{
          "type" : "value",
          "path" : "url"
        }],
        "ordered" : false,
        "rules" : "open"
      },
      "min" : 1,
      "mustSupport" : true
    },
    {
      "id" : "Coverage.subscriberId.extension:data-masked",
      "path" : "Coverage.subscriberId.extension",
      "sliceName" : "data-masked",
      "min" : 1,
      "max" : "1",
      "type" : [{
        "code" : "Extension",
        "profile" : ["http://hl7.org/fhir/StructureDefinition/data-absent-reason|5.2.0"]
      }],
      "mustSupport" : true
    },
    {
      "id" : "Coverage.subscriberId.extension:data-masked.value[x]",
      "path" : "Coverage.subscriberId.extension.value[x]",
      "fixedCode" : "masked"
    },
    {
      "id" : "Coverage.beneficiary",
      "path" : "Coverage.beneficiary",
      "label" : "Patient information (masked)",
      "short" : "Patient information (masked)",
      "definition" : "No personally-identifiable information is included in this profile. Instead, the patient element is populated with a Data Absent Reason = 'masked'"
    },
    {
      "id" : "Coverage.beneficiary.extension",
      "path" : "Coverage.beneficiary.extension",
      "min" : 1,
      "mustSupport" : true
    },
    {
      "id" : "Coverage.beneficiary.extension:data-masked",
      "path" : "Coverage.beneficiary.extension",
      "sliceName" : "data-masked",
      "min" : 1,
      "max" : "1",
      "type" : [{
        "code" : "Extension",
        "profile" : ["http://hl7.org/fhir/StructureDefinition/data-absent-reason|5.2.0"]
      }],
      "mustSupport" : true
    },
    {
      "id" : "Coverage.beneficiary.extension:data-masked.value[x]",
      "path" : "Coverage.beneficiary.extension.value[x]",
      "fixedCode" : "masked"
    },
    {
      "id" : "Coverage.beneficiary.reference",
      "path" : "Coverage.beneficiary.reference",
      "max" : "0"
    },
    {
      "id" : "Coverage.beneficiary.type",
      "path" : "Coverage.beneficiary.type",
      "max" : "0"
    },
    {
      "id" : "Coverage.beneficiary.identifier",
      "path" : "Coverage.beneficiary.identifier",
      "label" : "Unique, non-personally identifiable code",
      "short" : "Unique, non-personally identifiable code",
      "definition" : "A unique, non-personally identifiable code such as an anonymous account identifier",
      "comment" : "The beneficiary.identifier element in this profile is limited to only non-personally-identifiable codes, such as an account or user ID assigned during an anonymous interaction with the server."
    },
    {
      "id" : "Coverage.beneficiary.display",
      "path" : "Coverage.beneficiary.display",
      "max" : "0"
    },
    {
      "id" : "Coverage.relationship",
      "path" : "Coverage.relationship",
      "comment" : "In this non-PHI Coverage profile, always 'self'"
    },
    {
      "id" : "Coverage.relationship.coding.system",
      "path" : "Coverage.relationship.coding.system",
      "fixedUri" : "http://terminology.hl7.org/CodeSystem/subscriber-relationship"
    },
    {
      "id" : "Coverage.relationship.coding.code",
      "path" : "Coverage.relationship.coding.code",
      "fixedCode" : "self"
    },
    {
      "id" : "Coverage.payor.identifier",
      "path" : "Coverage.payor.identifier",
      "label" : "Payer ID",
      "short" : "Payer ID",
      "definition" : "Payer ID as defined in the participants' environment. E.g., an identifier defined in an eligibility service to represent the payer.",
      "mustSupport" : true
    },
    {
      "id" : "Coverage.payor.identifier.value",
      "path" : "Coverage.payor.identifier.value",
      "label" : "Payer ID Value",
      "short" : "Payer ID Value",
      "min" : 1,
      "mustSupport" : true
    },
    {
      "id" : "Coverage.class",
      "path" : "Coverage.class",
      "label" : "Pharmacy coverage identifiers",
      "slicing" : {
        "discriminator" : [{
          "type" : "value",
          "path" : "type"
        }],
        "description" : "Identifiers used by the payer/PBM to located the patient's coverage. IIN (BIN) number, Processor Control Number (PCN), pharmacy benefit Group ID and patient's PBM Member ID.",
        "ordered" : false,
        "rules" : "open"
      },
      "short" : "Pharmacy coverage identifiers",
      "definition" : "Identifiers used by the payer/PBM to located the patient's coverage. IIN (BIN) number, Processor Control Number (PCN), pharmacy benefit Group ID and patient's PBM Member ID.",
      "comment" : "Populate with identifiers retrieved from an eligibility service or other source agreed between trading partners"
    },
    {
      "id" : "Coverage.class.type",
      "path" : "Coverage.class.type",
      "binding" : {
        "strength" : "extensible",
        "description" : "Coverage Class Codes",
        "valueSet" : "http://hl7.org/fhir/ValueSet/coverage-class"
      }
    },
    {
      "id" : "Coverage.class:bin",
      "path" : "Coverage.class",
      "sliceName" : "bin",
      "label" : "IIN (BIN) number",
      "short" : "IIN (BIN) number",
      "min" : 0,
      "max" : "1",
      "mustSupport" : true
    },
    {
      "id" : "Coverage.class:bin.type",
      "path" : "Coverage.class.type",
      "patternCodeableConcept" : {
        "coding" : [{
          "system" : "http://terminology.hl7.org/CodeSystem/coverage-class",
          "code" : "rxbin"
        }]
      }
    },
    {
      "id" : "Coverage.class:pcn",
      "path" : "Coverage.class",
      "sliceName" : "pcn",
      "label" : "Processor Control Number (PCN)",
      "short" : "Processor Control Number (PCN)",
      "min" : 0,
      "max" : "1",
      "mustSupport" : true
    },
    {
      "id" : "Coverage.class:pcn.type",
      "path" : "Coverage.class.type",
      "patternCodeableConcept" : {
        "coding" : [{
          "system" : "http://terminology.hl7.org/CodeSystem/coverage-class",
          "code" : "rxpcn"
        }]
      }
    },
    {
      "id" : "Coverage.class:rxgroup-id",
      "path" : "Coverage.class",
      "sliceName" : "rxgroup-id",
      "label" : "Pharmacy Benefit Group ID",
      "short" : "Pharmacy Benefit Group ID",
      "min" : 0,
      "max" : "1",
      "mustSupport" : true
    },
    {
      "id" : "Coverage.class:rxgroup-id.type",
      "path" : "Coverage.class.type",
      "patternCodeableConcept" : {
        "coding" : [{
          "system" : "http://terminology.hl7.org/CodeSystem/coverage-class",
          "code" : "rxgroup"
        }]
      }
    },
    {
      "id" : "Coverage.class:member-id",
      "path" : "Coverage.class",
      "sliceName" : "member-id",
      "label" : "PBM Member ID",
      "short" : "PBM Member ID",
      "min" : 0,
      "max" : "1",
      "mustSupport" : true
    },
    {
      "id" : "Coverage.class:member-id.type",
      "path" : "Coverage.class.type",
      "patternCodeableConcept" : {
        "coding" : [{
          "system" : "http://terminology.hl7.org/CodeSystem/coverage-class",
          "code" : "rxid"
        }]
      }
    }]
  }
}

```
