description: This profile constrains the Coverage resource for carrying the pharmacy benefit information required in the consumer real-time pharmacy benefit check process
package_name: hl7.fhir.us.carin
derivation: constraint
name: RtpbcCoverage
type: Coverage
elements:
  subscriberId: {label: Health Plan Cardholder ID, short: Health Plan Cardholder ID, mustSupport: true, index: 0}
  beneficiary: {mustSupport: true, index: 1}
  payor:
    label: Payer ID
    short: Payer ID
    mustSupport: true
    index: 2
    elements:
      identifier:
        label: Payer ID
        short: Payer ID
        mustSupport: true
        index: 3
        elements:
          value: {label: Payer ID Value, short: Payer ID Value, mustSupport: true, index: 4}
        required: [value]
  class:
    short: Pharmacy coverage identifiers
    mustSupport: true
    array: true
    label: Pharmacy coverage identifiers
    index: 5
    elements:
      type:
        binding: {strength: extensible, valueSet: 'http://hl7.org/fhir/ValueSet/coverage-class'}
        index: 6
    slicing:
      rules: open
      ordered: false
      description: Identifiers used by the payer/PBM to located the patient's coverage. IIN (BIN) number, Processor Control Number (PCN), pharmacy benefit Group ID and patient's PBM Member ID.
      discriminator:
      - {path: type, type: value}
      min: 0
      slices:
        bin:
          match:
            type:
              coding:
              - {code: rxbin, system: 'http://terminology.hl7.org/CodeSystem/coverage-class'}
          schema:
            label: IIN (BIN) number
            short: IIN (BIN) number
            mustSupport: true
            index: 7
            elements:
              type:
                pattern:
                  type: CodeableConcept
                  value:
                    coding:
                    - {code: rxbin, system: 'http://terminology.hl7.org/CodeSystem/coverage-class'}
                index: 8
            required: [type]
        pcn:
          match:
            type:
              coding:
              - {code: rxpcn, system: 'http://terminology.hl7.org/CodeSystem/coverage-class'}
          schema:
            label: Processor Control Number (PCN)
            short: Processor Control Number (PCN)
            mustSupport: true
            index: 9
            elements:
              type:
                pattern:
                  type: CodeableConcept
                  value:
                    coding:
                    - {code: rxpcn, system: 'http://terminology.hl7.org/CodeSystem/coverage-class'}
                index: 10
            required: [type]
        rxgroup-id:
          match:
            type:
              coding:
              - {code: rxgroup, system: 'http://terminology.hl7.org/CodeSystem/coverage-class'}
          schema:
            short: Pharmacy Benefit Group ID
            mustSupport: true
            label: Pharmacy Benefit Group ID
            index: 11
            elements:
              type:
                pattern:
                  type: CodeableConcept
                  value:
                    coding:
                    - {code: rxgroup, system: 'http://terminology.hl7.org/CodeSystem/coverage-class'}
                index: 12
            required: [type]
        pbm-member-id:
          match:
            type:
              coding:
              - {code: rxid, system: 'http://terminology.hl7.org/CodeSystem/coverage-class'}
          schema:
            short: PBM Member ID
            mustSupport: true
            label: PBM Member ID
            index: 13
            elements:
              type:
                pattern:
                  type: CodeableConcept
                  value:
                    coding:
                    - {code: rxid, system: 'http://terminology.hl7.org/CodeSystem/coverage-class'}
                index: 14
            required: [type]
package_version: rtpbc-1.0.0
class: profile
kind: resource
url: http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-coverage
base: http://hl7.org/fhir/StructureDefinition/Coverage
version: 1.0.0