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 Patient Pay Type Code System (Temporary)

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

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    @prefix fhir: <http://hl7.org/fhir/> .
    @prefix owl: <http://www.w3.org/2002/07/owl#> .
    @prefix rdf: <http://www.w3.org/1999/02/22-rdf-syntax-ns#> .
    @prefix rdfs: <http://www.w3.org/2000/01/rdf-schema#> .
    @prefix xsd: <http://www.w3.org/2001/XMLSchema#> .

    # - resource -------------------------------------------------------------------

     a fhir:CodeSystem ;
      fhir:nodeRole fhir:treeRoot ;
      fhir:id [ fhir:v "rtpbc-patient-pay-type-temporary"] ; #
      fhir:language [ fhir:v "en"] ; #
      fhir:text [
    fhir:status [ fhir:v "generated" ] ;
    fhir:div [ fhir:v "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p class=\"res-header-id\"><b>Generated Narrative: CodeSystem rtpbc-patient-pay-type-temporary</b></p><a name=\"rtpbc-patient-pay-type-temporary\"> </a><a name=\"hcrtpbc-patient-pay-type-temporary\"> </a><p>This case-insensitive code system <code>http://hl7.org/fhir/us/carin-rtpbc/CodeSystem/rtpbc-patient-pay-type-temporary</code> defines the following codes:</p><table class=\"codes\"><tr><td style=\"white-space:nowrap\"><b>Code</b></td><td><b>Display</b></td><td><b>Definition</b></td></tr><tr><td style=\"white-space:nowrap\">deductible<a name=\"rtpbc-patient-pay-type-temporary-deductible\"> </a></td><td>Deductible</td><td>Amount to be collected from a patient to be applied to a periodic deductible</td></tr><tr><td style=\"white-space:nowrap\">accumulated-deductible<a name=\"rtpbc-patient-pay-type-temporary-accumulated-deductible\"> </a></td><td>Accumulated deductible</td><td>Total deductible paid after amount associated with this request</td></tr><tr><td style=\"white-space:nowrap\">remaining-deductible<a name=\"rtpbc-patient-pay-type-temporary-remaining-deductible\"> </a></td><td>Remaining deductible</td><td>Remaining deductible amount after payment associated with this request</td></tr><tr><td style=\"white-space:nowrap\">coinsurance<a name=\"rtpbc-patient-pay-type-temporary-coinsurance\"> </a></td><td>Per prescription coinsurance</td><td>Amount to be collected from a patient to satisfy a per prescription coinsurance</td></tr><tr><td style=\"white-space:nowrap\">copay<a name=\"rtpbc-patient-pay-type-temporary-copay\"> </a></td><td>Copay</td><td>Amount to be collected from the patient to satisfy a per prescription copay</td></tr><tr><td style=\"white-space:nowrap\">tax<a name=\"rtpbc-patient-pay-type-temporary-tax\"> </a></td><td>Tax</td><td>Amount to be collected from the patient for sales tax</td></tr><tr><td style=\"white-space:nowrap\">cash-price<a name=\"rtpbc-patient-pay-type-temporary-cash-price\"> </a></td><td>Full product cash price</td><td>Full product cash price before discounts or coupons</td></tr><tr><td style=\"white-space:nowrap\">coupon-discount<a name=\"rtpbc-patient-pay-type-temporary-coupon-discount\"> </a></td><td>Coupon discount amount</td><td>Coupon discount reducing the amount to be collected from the patient</td></tr><tr><td style=\"white-space:nowrap\">member-discount<a name=\"rtpbc-patient-pay-type-temporary-member-discount\"> </a></td><td>Member discount amount</td><td>Member discount reducing the amount to be collected from the patient</td></tr><tr><td style=\"white-space:nowrap\">other-discount<a name=\"rtpbc-patient-pay-type-temporary-other-discount\"> </a></td><td>Other discount amount</td><td>Other discount reducing the amount to be collected from the patient</td></tr><tr><td style=\"white-space:nowrap\">other-cost<a name=\"rtpbc-patient-pay-type-temporary-other-cost\"> </a></td><td>Other cost</td><td>Other amount to be collected from the patient</td></tr><tr><td style=\"white-space:nowrap\">eligible<a name=\"rtpbc-patient-pay-type-temporary-eligible\"> </a></td><td>Eligible amount</td><td>Amount that is considered for adjudication</td></tr><tr><td style=\"white-space:nowrap\">total<a name=\"rtpbc-patient-pay-type-temporary-total\"> </a></td><td>Total patient responsibility</td><td>Amount equalling the total patient responsibility for a prescription product's cost</td></tr></table></div>"^^rdf:XMLLiteral ]
      ] ; #
      fhir:extension ( [
    fhir:url [
    fhir:v "http://hl7.org/fhir/StructureDefinition/structuredefinition-fmm"^^xsd:anyURI ;
    fhir:l <http://hl7.org/fhir/StructureDefinition/structuredefinition-fmm>     ] ;
    fhir:value [
    a fhir:Integer ;
    fhir:v 2     ]
      ] [
    fhir:url [
    fhir:v "http://hl7.org/fhir/StructureDefinition/structuredefinition-wg"^^xsd:anyURI ;
    fhir:l <http://hl7.org/fhir/StructureDefinition/structuredefinition-wg>     ] ;
    fhir:value [
    a fhir:Code ;
    fhir:v "phx"     ]
      ] [
    fhir:url [
    fhir:v "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status"^^xsd:anyURI ;
    fhir:l <http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status>     ] ;
    fhir:value [
    a fhir:Code ;
    fhir:v "trial-use" ;
          ( fhir:extension [
    fhir:url [
    fhir:v "http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom"^^xsd:anyURI ;
    fhir:l <http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom>         ] ;
    fhir:value [
    a fhir:Canonical ;
    fhir:v "http://hl7.org/fhir/us/carin-rtpbc/ImplementationGuide/hl7.fhir.us.carin-rtpbc"^^xsd:anyURI ;
    fhir:l <http://hl7.org/fhir/us/carin-rtpbc/ImplementationGuide/hl7.fhir.us.carin-rtpbc>         ]       ] )     ]
      ] ) ; #
      fhir:url [
    fhir:v "http://hl7.org/fhir/us/carin-rtpbc/CodeSystem/rtpbc-patient-pay-type-temporary"^^xsd:anyURI ;
    fhir:l <http://hl7.org/fhir/us/carin-rtpbc/CodeSystem/rtpbc-patient-pay-type-temporary>
      ] ; #
      fhir:version [ fhir:v "2.0.0-ballot"] ; #
      fhir:name [ fhir:v "RtpbcPatientPayTypeCodeSystem"] ; #
      fhir:title [ fhir:v "RTPBC Patient Pay Type Code System (Temporary)"] ; #
      fhir:status [ fhir:v "active"] ; #
      fhir:experimental [ fhir:v false] ; #
      fhir:date [ fhir:v "2026-03-01T00:00:00-05:00"^^xsd:dateTime] ; #
      fhir:publisher [ fhir:v "HL7 International / Pharmacy"] ; #
      fhir:contact ( [
    fhir:name [ fhir:v "HL7 International / Pharmacy" ] ;
        ( fhir:telecom [
    fhir:system [ fhir:v "url" ] ;
    fhir:value [ fhir:v "http://www.hl7.org/Special/committees/medication" ]     ] )
      ] [
    fhir:name [ fhir:v "Frank McKinney" ] ;
        ( fhir:telecom [
    fhir:system [ fhir:v "email" ] ;
    fhir:value [ fhir:v "fm@frankmckinney.com" ]     ] )
      ] ) ; #
      fhir:description [ fhir:v "This code system defines components of a patient's responsibility for a prescription product's cost. (The contents of this code system are expected to be incorporated into the THO code system https://terminology.hl7.org/en/CodeSystem-adjudication.html)"] ; #
      fhir:jurisdiction ( [
        ( fhir:coding [
    fhir:system [
    fhir:v "urn:iso:std:iso:3166"^^xsd:anyURI ;
    fhir:l <urn:iso:std:iso:3166>       ] ;
    fhir:code [ fhir:v "US" ] ;
    fhir:display [ fhir:v "United States of America" ]     ] )
      ] ) ; #
      fhir:caseSensitive [ fhir:v false] ; #
      fhir:content [ fhir:v "complete"] ; #
      fhir:count [ fhir:v "13"^^xsd:nonNegativeInteger] ; #
      fhir:concept ( [
    fhir:code [ fhir:v "deductible" ] ;
    fhir:display [ fhir:v "Deductible" ] ;
    fhir:definition [ fhir:v "Amount to be collected from a patient to be applied to a periodic deductible" ]
      ] [
    fhir:code [ fhir:v "accumulated-deductible" ] ;
    fhir:display [ fhir:v "Accumulated deductible" ] ;
    fhir:definition [ fhir:v "Total deductible paid after amount associated with this request" ]
      ] [
    fhir:code [ fhir:v "remaining-deductible" ] ;
    fhir:display [ fhir:v "Remaining deductible" ] ;
    fhir:definition [ fhir:v "Remaining deductible amount after payment associated with this request" ]
      ] [
    fhir:code [ fhir:v "coinsurance" ] ;
    fhir:display [ fhir:v "Per prescription coinsurance" ] ;
    fhir:definition [ fhir:v "Amount to be collected from a patient to satisfy a per prescription coinsurance" ]
      ] [
    fhir:code [ fhir:v "copay" ] ;
    fhir:display [ fhir:v "Copay" ] ;
    fhir:definition [ fhir:v "Amount to be collected from the patient to satisfy a per prescription copay" ]
      ] [
    fhir:code [ fhir:v "tax" ] ;
    fhir:display [ fhir:v "Tax" ] ;
    fhir:definition [ fhir:v "Amount to be collected from the patient for sales tax" ]
      ] [
    fhir:code [ fhir:v "cash-price" ] ;
    fhir:display [ fhir:v "Full product cash price" ] ;
    fhir:definition [ fhir:v "Full product cash price before discounts or coupons" ]
      ] [
    fhir:code [ fhir:v "coupon-discount" ] ;
    fhir:display [ fhir:v "Coupon discount amount" ] ;
    fhir:definition [ fhir:v "Coupon discount reducing the amount to be collected from the patient" ]
      ] [
    fhir:code [ fhir:v "member-discount" ] ;
    fhir:display [ fhir:v "Member discount amount" ] ;
    fhir:definition [ fhir:v "Member discount reducing the amount to be collected from the patient" ]
      ] [
    fhir:code [ fhir:v "other-discount" ] ;
    fhir:display [ fhir:v "Other discount amount" ] ;
    fhir:definition [ fhir:v "Other discount reducing the amount to be collected from the patient" ]
      ] [
    fhir:code [ fhir:v "other-cost" ] ;
    fhir:display [ fhir:v "Other cost" ] ;
    fhir:definition [ fhir:v "Other amount to be collected from the patient" ]
      ] [
    fhir:code [ fhir:v "eligible" ] ;
    fhir:display [ fhir:v "Eligible amount" ] ;
    fhir:definition [ fhir:v "Amount that is considered for adjudication" ]
      ] [
    fhir:code [ fhir:v "total" ] ;
    fhir:display [ fhir:v "Total patient responsibility" ] ;
    fhir:definition [ fhir:v "Amount equalling the total patient responsibility for a prescription product's cost" ]
      ] ) . #