Consumer Real-Time Pharmacy Benefit Check FHIR IG
2.0.0-ballot - STU 2 Ballot
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
{
"resourceType" : "Bundle",
"id" : "rtpbc-bundle-response-discount-card",
"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-discount-card",
"resource" : {
"resourceType" : "MessageHeader",
"id" : "rtpbc-messageheader-response-discount-card",
"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-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>"
},
"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-discount-card"
}
],
"definition" : "http://hl7.org/fhir/us/carin-rtpbc/MessageDefinition/rtpbc-response-non-phi"
}
},
{
"fullUrl" : "http://example.org/my-app/ClaimResponse/rtpbc-claim-response-discount-card",
"resource" : {
"resourceType" : "ClaimResponse",
"id" : "rtpbc-claim-response-discount-card",
"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-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>"
},
"identifier" : [
{
"value" : "rtpbc-03-response-discount-card"
}
],
"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" : [
{
"extension" : [
{
"url" : "http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-relatedCoverage",
"valueReference" : {
🔗 "reference" : "Coverage/rtpbc-coverage-non-phi-01"
}
}
],
"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
},
{
"url" : "http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-relatedCoverage",
"valueReference" : {
🔗 "reference" : "Coverage/rtpbc-coverage-non-phi-01"
}
}
],
"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"
}
}
]
}
]
}
},
{
"fullUrl" : "http://example.org/my-app/Coverage/rtpbc-coverage-non-phi-01",
"resource" : {
"resourceType" : "Coverage",
"id" : "rtpbc-coverage-non-phi-01",
"meta" : {
"profile" : [
🔗 "http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-coverage-non-phi"
]
},
"language" : "en",
"text" : {
"status" : "extensions",
"div" : "<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>"
},
"status" : "active",
"_subscriberId" : {
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/data-absent-reason",
"valueCode" : "masked"
}
]
},
"beneficiary" : {
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/data-absent-reason",
"valueCode" : "masked"
}
]
},
"relationship" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/subscriber-relationship",
"code" : "self"
}
]
},
"payor" : [
{
"identifier" : {
"value" : "Med Discounts"
}
}
],
"class" : [
{
"type" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/coverage-class",
"code" : "rxbin"
}
]
},
"value" : "BIN001"
},
{
"type" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/coverage-class",
"code" : "rxpcn"
}
]
},
"value" : "PCN002"
},
{
"type" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/coverage-class",
"code" : "rxgroup"
}
]
},
"value" : "GROUP0001"
},
{
"type" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/coverage-class",
"code" : "rxid"
}
]
},
"value" : "MEMBER000001"
}
]
}
}
]
}
IG © 2020+ HL7 International / Pharmacy.
Package hl7.fhir.us.carin-rtpbc#2.0.0-ballot based on FHIR 4.0.1.
Generated
2026-03-31
Links: Table of Contents |
QA Report
| Version History |
|
Propose a change