Consumer Real-Time Pharmacy Benefit Check FHIR IG
2.0.0-ballot - STU 2 Ballot United States of America flag

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-price-source

Raw xml | Download


<Bundle xmlns="http://hl7.org/fhir">
  <id value="rtpbc-bundle-response-price-source"/>
  <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-price-source"/>
    <resource>
      <MessageHeader>
        <id value="rtpbc-messageheader-response-price-source"/>
        <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-price-source"> </a><p class="res-header-id"><b>Generated Narrative: MessageHeader rtpbc-messageheader-response-price-source</b></p><a name="rtpbc-messageheader-response-price-source"> </a><a name="hcrtpbc-messageheader-response-price-source"> </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-price-source.html#http-//example.org/my-app/ClaimResponse/rtpbc-claim-response-price-source">ClaimResponse: identifier = rtpbc-response-price-source; 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-price-source"/>
        </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-price-source"/>
    <resource>
      <ClaimResponse>
        <id value="rtpbc-claim-response-price-source"/>
        <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-price-source"> </a><p class="res-header-id"><b>Generated Narrative: ClaimResponse rtpbc-claim-response-price-source</b></p><a name="rtpbc-claim-response-price-source"> </a><a name="hcrtpbc-claim-response-price-source"> </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-response-price-source</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>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>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-response-price-source"/>
        </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>
          <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>
          <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>
</Bundle>