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
<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>
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
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