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
