IP Review

This publication includes IP covered under the following statements.

ISO maintains the copyright on the country codes, and controls its use carefully. For further details see the ISO 3166 web page: https://www.iso.org/iso-3166-country-codes.html
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- ISO 3166-1 Codes for the representation of names of countries and their subdivisions — Part 1: Country code : ConsumerRealTimePharmacyBenefitCheck , NCPDPFormularyStatusCodeSystem ... Show 43 more
The UCUM codes, UCUM table (regardless of format), and UCUM Specification are copyright 1999-2009, Regenstrief Institute, Inc. and the Unified Codes for Units of Measures (UCUM) Organization. All rights reserved. https://ucum.org/trac/wiki/TermsOfUse
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- Unified Code for Units of Measure (UCUM) : Bundle/rtpbc-bundle-request-01 , MedicationRequest/rtpbc-medicationrequest-01 ... Show 6 more
This material derives from the HL7 Terminology (THO). THO is copyright ©1989+ Health Level Seven International and is made available under the CC0 designation. For more licensing information see: https://terminology.hl7.org/license.html
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Using RxNorm codes of type SAB=RXNORM as this specification describes does not require a UMLS license. Access to the full set of RxNorm definitions, and/or additional use of other RxNorm structures and information requires a UMLS license. The use of RxNorm in this specification is pursuant to HL7's status as a licensee of the NLM UMLS. HL7's license does not convey the right to use RxNorm to any users of this specification; implementers must acquire a license to use RxNorm in their own right.
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- RxNorm : Bundle/rtpbc-bundle-request-01 , Bundle/rtpbc-bundle-request-non-phi-1 ... Show 18 more

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 | CC0 | Propose a change ( src )

hl7.fhir.us.hai: Healthcare Associated Infection Implementation Guide ®© HL7 | CC0 ( src )

Consumer RTPBC adapts the predetermination process supported by the FHIR® Claim and ClaimResponse resources to request patient-specific medication coverage information from the insurer and cash pricing, discount cards and supporting information from other data sources. Accompanying FHIR® resources carry related information including patient and insurance coverage details, medication, prescriber and preferred pharmacy. A request format that omits personally-identifiable information is also included for data sources that don't require patient specifics. ( src )

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 ( src )

Like the option above, the $process-message operation takes a single FHIR® resource input parameter consisting of a Bundle containing the Claim resource and referenced supporting resources, and returns a Bundle containing a ClaimResponse and supporting resources. ( src )

The consumer RTPBC request and response are accomplished using FHIR Claim and ClaimResponse resources in a "predetermination" (what-if) mode. Other FHIR® resources support the exchange by fleshing out patient, prescription, pharmacy and coverage information needed to determine accurate cost and coverage. An OperationOutcome communicates exception situations where a ClaimResponse cannot be returned. ( src )

There are examples where a medication request may include the option of an oral dose or an Intravenous or Intramuscular dose. For example, "Ondansetron 8mg orally or IV twice a day as needed for nausea" or "Compazine® (prochlorperazine) 5-10mg PO or 25mg PR bid prn nausea or vomiting". In these cases, two medication requests would be created that could be grouped together. The decision on which dose and route of administration to use is based on the patient's condition at the time the dose is needed. ( src )

This is a guide for implementing a consumer-focused Real-time Pharmacy Benefit Check (RTPBC) process using HL7 FHIR®. ( src )

This material derives from the HL7 Terminology (THO). THO is copyright ©1989+ Health Level Seven International and is made available under the CC0 designation. For more licensing information see: https://terminology.hl7.org/license.html Show Usage * Claim Type Codes: Bundle/rtpbc-bundle-request-01, Bundle/rtpbc-bundle-request-non-phi-1... Show 11 more, Bundle/rtpbc-bundle-request-non-phi-2, Bundle/rtpbc-bundle-response-01, Bundle/rtpbc-bundle-response-discount-card, Bundle/rtpbc-bundle-response-price-source, Claim/rtpbc-claim-01, Claim/rtpbc-claim-non-phi-1, Claim/rtpbc-claim-non-phi-2, ClaimResponse/rtpbc-claim-response-01, ClaimResponse/rtpbc-claim-response-discount-card, ClaimResponse/rtpbc-claim-response-not-covered and ClaimResponse/rtpbc-claim-response-price-source * Coverage Class Codes: Bundle/rtpbc-bundle-request-01, Bundle/rtpbc-bundle-response-discount-card... Show 4 more, Coverage/rtpbc-coverage-01, Coverage/rtpbc-coverage-non-phi-01, RtpbcCoverage and RtpbcCoverageNonPHI * Process Priority Codes: Bundle/rtpbc-bundle-request-01, Bundle/rtpbc-bundle-request-non-phi-1... Show 4 more, Bundle/rtpbc-bundle-request-non-phi-2, Claim/rtpbc-claim-01, Claim/rtpbc-claim-non-phi-1 and Claim/rtpbc-claim-non-phi-2 * SubscriberPolicyholder Relationship Codes: Bundle/rtpbc-bundle-request-01, Bundle/rtpbc-bundle-response-discount-card, Coverage/rtpbc-coverage-01 and Coverage/rtpbc-coverage-non-phi-01 * identifierType: Bundle/rtpbc-bundle-request-01, Bundle/rtpbc-bundle-response-01... Show 4 more, Patient/rtpbc-patient-01, Patient/rtpbc-patient-03ps, RtpbcCoverage and RtpbcCoverageNonPHI ( src )

External References

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