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-discount-card

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    <Bundle xmlns="http://hl7.org/fhir">
      <id value="rtpbc-bundle-response-discount-card"/>
      <meta>
        <profile
                 value="http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-response-bundle-non-phi"/>
      </meta>
      <language value="en"/>
      <type value="message"/>
      <timestamp value="2025-11-15T13:10:13-05:00"/>
      <entry>
        <fullUrl
                 value="http://example.org/my-app/MessageHeader/rtpbc-messageheader-response-discount-card"/>
        <resource>
          <MessageHeader>
            <id value="rtpbc-messageheader-response-discount-card"/>
            <meta>
              <profile
                       value="http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-response-messageheader-non-phi"/>
            </meta>
            <language value="en"/>
            <text>
              <status value="generated"/>
              <div xmlns="http://www.w3.org/1999/xhtml"><a name="MessageHeader_rtpbc-messageheader-response-discount-card"> </a><p class="res-header-id"><b>Generated Narrative: MessageHeader rtpbc-messageheader-response-discount-card</b></p><a name="rtpbc-messageheader-response-discount-card"> </a><a name="hcrtpbc-messageheader-response-discount-card"> </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-discount-card.html#http-//example.org/my-app/ClaimResponse/rtpbc-claim-response-discount-card">ClaimResponse: identifier = rtpbc-03-response-discount-card; 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>
            </text>
            <eventCoding>
              <system
                      value="http://hl7.org/fhir/us/carin-rtpbc/CodeSystem/rtpbc-event-type"/>
              <code value="rtpbc-response-non-phi"/>
              <display value="RTPBC Non-PHI Response"/>
            </eventCoding>
            <source>
              <name value="GoodPricing"/>
              <endpoint value="http://example.org/GoodPricing/fhir"/>
            </source>
            <response>
              <identifier value="rtpbc-messageheader-request-non-phi-1"/>
              <code value="ok"/>
            </response>
            <focus>
              <reference
                         value="http://example.org/my-app/ClaimResponse/rtpbc-claim-response-discount-card"/>
            </focus>
            <definition
                        value="http://hl7.org/fhir/us/carin-rtpbc/MessageDefinition/rtpbc-response-non-phi"/>
          </MessageHeader>
        </resource>
      </entry>
      <entry>
        <fullUrl
                 value="http://example.org/my-app/ClaimResponse/rtpbc-claim-response-discount-card"/>
        <resource>
          <ClaimResponse>
            <id value="rtpbc-claim-response-discount-card"/>
            <meta>
              <profile
                       value="http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-response-claimresponse-non-phi"/>
            </meta>
            <language value="en"/>
            <text>
              <status value="extensions"/>
              <div xmlns="http://www.w3.org/1999/xhtml"><a name="ClaimResponse_rtpbc-claim-response-discount-card"> </a><p class="res-header-id"><b>Generated Narrative: ClaimResponse rtpbc-claim-response-discount-card</b></p><a name="rtpbc-claim-response-discount-card"> </a><a name="hcrtpbc-claim-response-discount-card"> </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-03-response-discount-card</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>RTPBC relatedCoverage Extension</b>: <a href="Coverage-rtpbc-coverage-non-phi-01.html">Coverage: status = active; subscriberId = ; relationship = Self</a></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>RTPBC relatedCoverage Extension</b>: <a href="Coverage-rtpbc-coverage-non-phi-01.html">Coverage: status = active; subscriberId = ; relationship = Self</a></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>
            </text>
            <identifier>
              <value value="rtpbc-03-response-discount-card"/>
            </identifier>
            <status value="active"/>
            <type>
              <coding>
                <system value="http://terminology.hl7.org/CodeSystem/claim-type"/>
                <code value="pharmacy"/>
                <display value="Pharmacy"/>
              </coding>
            </type>
            <use value="predetermination"/>
            <patient>
              <extension
                         url="http://hl7.org/fhir/StructureDefinition/data-absent-reason">
                <valueCode value="masked"/>
              </extension>
            </patient>
            <created value="2025-11-15T13:10:13-05:00"/>
            <insurer>
              <extension
                         url="http://hl7.org/fhir/StructureDefinition/data-absent-reason">
                <valueCode value="masked"/>
              </extension>
            </insurer>
            <request>
              <identifier>
                <value value="rtpbc-01"/>
              </identifier>
            </request>
            <outcome value="complete"/>
            <disposition value="Processed successfully"/>
            <item>
              <extension
                         url="http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-relatedCoverage">
                <valueReference>🔗
                  <reference value="Coverage/rtpbc-coverage-non-phi-01"/>
                </valueReference>
              </extension>
              <itemSequence value="1"/>
              <noteNumber value="1"/>
              <adjudication>
                <category>
                  <coding>
                    <system
                            value="http://hl7.org/fhir/us/carin-rtpbc/CodeSystem/rtpbc-patient-pay-type-temporary"/>
                    <code value="cash-price"/>
                    <display value="Full product cash price"/>
                  </coding>
                </category>
                <amount>
                  <value value="105"/>
                  <currency value="USD"/>
                </amount>
              </adjudication>
              <adjudication>
                <category>
                  <coding>
                    <system
                            value="http://hl7.org/fhir/us/carin-rtpbc/CodeSystem/rtpbc-patient-pay-type-temporary"/>
                    <code value="coupon-discount"/>
                    <display value="Coupon discount amount"/>
                  </coding>
                </category>
                <amount>
                  <value value="-20"/>
                  <currency value="USD"/>
                </amount>
              </adjudication>
              <adjudication>
                <category>
                  <coding>
                    <system
                            value="http://hl7.org/fhir/us/carin-rtpbc/CodeSystem/rtpbc-patient-pay-type-temporary"/>
                    <code value="total"/>
                    <display value="Total patient responsibility"/>
                  </coding>
                </category>
                <amount>
                  <value value="85"/>
                  <currency value="USD"/>
                </amount>
              </adjudication>
            </item>
            <addItem>
              <extension
                         url="http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-isAlternative">
                <valueBoolean value="true"/>
              </extension>
              <extension
                         url="http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-relatedCoverage">
                <valueReference>🔗
                  <reference value="Coverage/rtpbc-coverage-non-phi-01"/>
                </valueReference>
              </extension>
              <itemSequence value="1"/>
              <productOrService>
                <coding>
                  <system value="http://www.nlm.nih.gov/research/umls/rxnorm"/>
                  <code value="205535"/>
                  <display value="fluoxetine 10 MG Oral Capsule [Prozac]"/>
                </coding>
              </productOrService>
              <quantity>
                <value value="60"/>
                <unit value="{Each}"/>
              </quantity>
              <adjudication>
                <category>
                  <coding>
                    <system
                            value="http://hl7.org/fhir/us/carin-rtpbc/CodeSystem/rtpbc-patient-pay-type-temporary"/>
                    <code value="cash-price"/>
                    <display value="Full product cash price"/>
                  </coding>
                </category>
                <amount>
                  <value value="50"/>
                  <currency value="USD"/>
                </amount>
              </adjudication>
              <adjudication>
                <category>
                  <coding>
                    <system
                            value="http://hl7.org/fhir/us/carin-rtpbc/CodeSystem/rtpbc-patient-pay-type-temporary"/>
                    <code value="coupon-discount"/>
                    <display value="Coupon discount amount"/>
                  </coding>
                </category>
                <amount>
                  <value value="-10"/>
                  <currency value="USD"/>
                </amount>
              </adjudication>
              <adjudication>
                <category>
                  <coding>
                    <system
                            value="http://hl7.org/fhir/us/carin-rtpbc/CodeSystem/rtpbc-patient-pay-type-temporary"/>
                    <code value="total"/>
                    <display value="Total patient responsibility"/>
                  </coding>
                </category>
                <amount>
                  <value value="40"/>
                  <currency value="USD"/>
                </amount>
              </adjudication>
            </addItem>
          </ClaimResponse>
        </resource>
      </entry>
      <entry>
        <fullUrl
                 value="http://example.org/my-app/Coverage/rtpbc-coverage-non-phi-01"/>
        <resource>
          <Coverage>
            <id value="rtpbc-coverage-non-phi-01"/>
            <meta>
              <profile
                       value="http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-coverage-non-phi"/>
            </meta>
            <language value="en"/>
            <text>
              <status value="extensions"/>
              <div xmlns="http://www.w3.org/1999/xhtml"><a name="Coverage_rtpbc-coverage-non-phi-01"> </a><p class="res-header-id"><b>Generated Narrative: Coverage rtpbc-coverage-non-phi-01</b></p><a name="rtpbc-coverage-non-phi-01"> </a><a name="hcrtpbc-coverage-non-phi-01"> </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-coverage-non-phi.html">RTPBC Coverage - Non-PHI</a></p></div><p><b>status</b>: Active</p><p><b>subscriberId</b>: Absent because : masked</p><p><b>beneficiary</b>: ?rref?</p><p><b>relationship</b>: <span title="Codes:{http://terminology.hl7.org/CodeSystem/subscriber-relationship self}">Self</span></p><p><b>payor</b>: Identifier: Med Discounts</p><blockquote><p><b>class</b></p><p><b>type</b>: <span title="Codes:{http://terminology.hl7.org/CodeSystem/coverage-class rxbin}">RX BIN</span></p><p><b>value</b>: BIN001</p></blockquote><blockquote><p><b>class</b></p><p><b>type</b>: <span title="Codes:{http://terminology.hl7.org/CodeSystem/coverage-class rxpcn}">RX PCN</span></p><p><b>value</b>: PCN002</p></blockquote><blockquote><p><b>class</b></p><p><b>type</b>: <span title="Codes:{http://terminology.hl7.org/CodeSystem/coverage-class rxgroup}">RX Group</span></p><p><b>value</b>: GROUP0001</p></blockquote><blockquote><p><b>class</b></p><p><b>type</b>: <span title="Codes:{http://terminology.hl7.org/CodeSystem/coverage-class rxid}">RX Id</span></p><p><b>value</b>: MEMBER000001</p></blockquote></div>
            </text>
            <status value="active"/>
            <subscriberId>
              <extension
                         url="http://hl7.org/fhir/StructureDefinition/data-absent-reason">
                <valueCode value="masked"/>
              </extension>
            </subscriberId>
            <beneficiary>
              <extension
                         url="http://hl7.org/fhir/StructureDefinition/data-absent-reason">
                <valueCode value="masked"/>
              </extension>
            </beneficiary>
            <relationship>
              <coding>
                <system
                        value="http://terminology.hl7.org/CodeSystem/subscriber-relationship"/>
                <code value="self"/>
              </coding>
            </relationship>
            <payor>
              <identifier>
                <value value="Med Discounts"/>
              </identifier>
            </payor>
            <class>
              <type>
                <coding>
                  <system
                          value="http://terminology.hl7.org/CodeSystem/coverage-class"/>
                  <code value="rxbin"/>
                </coding>
              </type>
              <value value="BIN001"/>
            </class>
            <class>
              <type>
                <coding>
                  <system
                          value="http://terminology.hl7.org/CodeSystem/coverage-class"/>
                  <code value="rxpcn"/>
                </coding>
              </type>
              <value value="PCN002"/>
            </class>
            <class>
              <type>
                <coding>
                  <system
                          value="http://terminology.hl7.org/CodeSystem/coverage-class"/>
                  <code value="rxgroup"/>
                </coding>
              </type>
              <value value="GROUP0001"/>
            </class>
            <class>
              <type>
                <coding>
                  <system
                          value="http://terminology.hl7.org/CodeSystem/coverage-class"/>
                  <code value="rxid"/>
                </coding>
              </type>
              <value value="MEMBER000001"/>
            </class>
          </Coverage>
        </resource>
      </entry>
    </Bundle>