CARIN Consumer Realtime Pharmacy Benefit Check - Local Development build (v0.1.00-DRAFT). See the Directory of published versions
Terminology overview
Terminology incorporated in the IG
Consumer RTPBC exchanges involve common medical terminology as well as code sets that are specific to pharmacy benefit processing. Most of these pharmacy benefit code sets are proprietary to the National Council for Prescription Drug Programs (NCPDP). This effort is working with NCPDP and the HL7 Pharmacy and Financial Management Workgroups to determine an appropriate way to reference these code sets.
Terminology used in the RTPBC process
- NDC11 to identify the prescribed drug, subset of quantity units for the prescribed quantity, coverage level for the medication
- NPI and NCPDP ID to identify the pharmacy
- Specify the set of adjudication concepts that apply to consumer RTPBC
- Adjudication categories (e.g., copay)
- Pharmacy benefit type (e.g., retail, mail order)
- Coverage level (e.g., covered, not covered, covered with restrictions)
- US, Canada and Military state / province identifiers
To be expanded
