CARIN Consumer Realtime Pharmacy Benefit Check Implementation Guide CI Build

CARIN Consumer Realtime Pharmacy Benefit Check - Local Development build (v0.1.00-DRAFT). See the Directory of published versions

Profiles defined as part of this Guide



Profiles

Name Description
CarinRtpbcExceptionResponse This profile constrains the OperationOutcome resource for communicating situations when an exception prevents an insurer from returning a consumer real-time pharmacy benefit check response.
CarinRtpbcPharmacy
CarinRtpbcRequest This profile constrains the Claim resource so that it can serve as the *RTPBC Request* in the consumer real-time pharmacy benefit check process
CarinRtpbcRequestCoverageIdentifiers This profile constrains the Coverage resource for carrying the pharmacy benefit information required in the consumer real-time pharmacy benefit check process
CarinRtpbcRequestPatientInfo This profile constrains the Patient resource for carrying the limited patient information required in the consumer real-time pharmacy benefit check (RTPBC) process. In RTPBC, the sole purpose of patient information is to enable the responding payer/PBM to locate the patient's insurance information. From there, pricing and coverage information is determined based on the patient's member and coverage information maintained by the payer.
CarinRtpbcRequestPrescriberInfo This profile constrains the Practitioner resource to convey identifying prescriber information required in the consumer real-time pharmacy benefit check (RTPBC) process.
CarinRtpbcRequestPrescriptionInfo This profile constrains the MedicationRequest resource to convey a subset of prescription information required in the consumer real-time pharmacy benefit check (RTPBC) process. The content specifies the prescribed product and quantity, and references the prescribing practitioner and the patients' preferred pharmacy
CarinRtpbcResponse This profile constrains the ClaimResponse resource to serve as the RTPBC Response in the consumer real-time pharmacy benefit check process. It uses the ClaimResponse's "predetermination" processing mode

Extensions

No extensions are defined for this implementation guide