description: This profile omits persoanlly-identifiable content in an RTPBC response. To be used by data sources that can provide benefit or price information without receiving patient details. package_name: hl7.fhir.us.carin-rtpbc derivation: constraint name: RtpbcResponseClaimResponseNonPHI type: ClaimResponse elements: patient: label: Patient information (masked) short: Patient information (masked) index: 10 extensions: data-masked: url: http://hl7.org/fhir/StructureDefinition/data-absent-reason|5.2.0 type: Extension mustSupport: true index: 12 elements: value: pattern: {type: Code, value: masked} choices: [] index: 14 elements: extension: mustSupport: true index: 11 slicing: slices: data-masked: match: {} schema: type: Extension mustSupport: true url: http://hl7.org/fhir/StructureDefinition/data-absent-reason|5.2.0 index: 12 elements: value: pattern: {type: Code, value: masked} choices: [] index: 14 reference: {index: 15} type: {index: 16} identifier: {label: 'Unique, non-personally identifiable code', short: 'Unique, non-personally identifiable code', index: 17} display: {index: 18} required: [extension] request: label: Submitter's RTPBC Request ID short: Submitter's RTPBC Request ID mustSupport: true index: 24 elements: identifier: mustSupport: true index: 25 elements: value: {label: RTPBC Request ID, short: RTPBC Request ID, mustSupport: true, index: 26} required: [value] required: [identifier] processNote: label: Determination Note short: Determination Note mustSupport: true index: 68 elements: number: {label: Determination Note Number, short: Determination Note Number, mustSupport: true, index: 69} text: {label: Determination Note Text, short: Determination Note Text, mustSupport: true, index: 70} required: [number] use: label: Processing Mode short: Processing Mode pattern: {type: Code, value: predetermination} mustSupport: true index: 9 item: label: Requested Product and Pharmacy short: Requested Product and Pharmacy mustSupport: true index: 29 extensions: benefitRestriction: {url: 'http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-benefitRestriction', min: 0, short: Benefit Restriction (Extension), type: Extension, mustSupport: true, index: 31} formularyStatus: {url: 'http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-formularyStatus', min: 0, max: 1, short: Formulary Status (Extension), type: Extension, mustSupport: true, index: 32} preferenceLevel: {url: 'http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-preferenceLevel', min: 0, max: 1, short: Preference Level (Extension), type: Extension, mustSupport: true, index: 33} nextAvailableFillDate: {url: 'http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-nextAvailableFillDate', min: 0, max: 1, short: Next Available Fill Date (Extension), type: Extension, mustSupport: true, index: 34} relatedCoverage: {url: 'http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-relatedCoverage', min: 0, short: Related Coverage (Extension), type: Extension, mustSupport: true, index: 35} elements: extension: index: 30 slicing: rules: open ordered: false discriminator: - {path: url, type: value} min: null slices: benefitRestriction: match: {url: null} schema: {short: Benefit Restriction (Extension), type: Extension, mustSupport: true, url: 'http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-benefitRestriction', index: 31} min: 0 formularyStatus: match: {url: null} schema: {short: Formulary Status (Extension), type: Extension, mustSupport: true, url: 'http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-formularyStatus', index: 32} min: 0 max: 1 preferenceLevel: match: {url: null} schema: {short: Preference Level (Extension), type: Extension, mustSupport: true, url: 'http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-preferenceLevel', index: 33} min: 0 max: 1 nextAvailableFillDate: match: {url: null} schema: {short: Next Available Fill Date (Extension), type: Extension, mustSupport: true, url: 'http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-nextAvailableFillDate', index: 34} min: 0 max: 1 relatedCoverage: match: {url: null} schema: {short: Related Coverage (Extension), type: Extension, mustSupport: true, url: 'http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-relatedCoverage', index: 35} min: 0 itemSequence: {mustSupport: true, index: 36} noteNumber: {label: Determination Note Number, short: Determination Note Number, mustSupport: true, index: 37} adjudication: label: Requested Product and Pharmacy Determination short: Requested Product and Pharmacy Determination mustSupport: true index: 38 elements: category: short: Patient Pay Component mustSupport: true binding: {strength: required, valueSet: 'http://hl7.org/fhir/us/carin-rtpbc/ValueSet/rtpbc-patient-pay-type'} label: Patient Pay Component index: 39 amount: label: Patient Pay Component Amount short: Patient Pay Component Amount mustSupport: true index: 40 elements: value: {label: Patient Pay Amount Value, short: Patient Pay Amount Value, mustSupport: true, index: 41} currency: label: Patient Pay Amount Currency short: Patient Pay Amount Currency binding: {strength: required, valueSet: 'http://hl7.org/fhir/ValueSet/currencies'} mustSupport: true index: 42 required: [currency, value] required: [amount] type: label: Requested Service Type short: Requested Service Type mustSupport: true index: 4 elements: coding: mustSupport: true index: 5 elements: system: pattern: {type: Uri, value: 'http://terminology.hl7.org/CodeSystem/claim-type'} mustSupport: true index: 6 code: pattern: {type: Code, value: pharmacy} mustSupport: true index: 7 display: pattern: {type: String, value: Pharmacy} mustSupport: true index: 8 required: [display, system, code] required: [coding] outcome: {label: Processing Outcome, short: Processing Outcome, mustSupport: true, index: 27} disposition: {label: Completed Note, short: Completed Note, mustSupport: true, index: 28} insurer: label: Insurer (masked) short: Insurer (masked) index: 19 extensions: data-masked: url: http://hl7.org/fhir/StructureDefinition/data-absent-reason|5.2.0 type: Extension mustSupport: true index: 21 elements: value: pattern: {type: Code, value: masked} choices: [] index: 23 elements: extension: mustSupport: true index: 20 slicing: slices: data-masked: match: {} schema: type: Extension mustSupport: true url: http://hl7.org/fhir/StructureDefinition/data-absent-reason|5.2.0 index: 21 elements: value: pattern: {type: Code, value: masked} choices: [] index: 23 required: [extension] status: label: Response status short: Response status pattern: {type: Code, value: active} mustSupport: true index: 3 id: {label: Unique ClaimResponse Resource Identifier, short: Unique ClaimResponse Resource Identifier, mustSupport: true, index: 0} identifier: label: RTPBC Response Identifier short: RTPBC Response Identifier mustSupport: true index: 1 elements: value: {label: Unique RTPBC response ID, short: Unique RTPBC response ID, mustSupport: true, index: 2} required: [value] error: label: Error Information short: Error Information mustSupport: true index: 71 elements: code: label: Reject Reason short: Reject Reason binding: {strength: preferred, valueSet: 'http://hl7.org/fhir/us/carin-rtpbc/ValueSet/rtpbc-error-code'} mustSupport: true index: 72 elements: coding: mustSupport: true index: 73 elements: system: {mustSupport: true, index: 74} code: {label: Reject Code, short: Reject Code, mustSupport: true, index: 75} display: {mustSupport: true, index: 76} required: [display, system, code] text: {label: Reject Message, short: Reject Message, mustSupport: true, index: 77} required: [coding] addItem: mustSupport: true index: 43 extensions: isAlternative: {url: 'http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-isAlternative', min: 1, max: 1, short: Is Alternative (Extension), type: Extension, mustSupport: true, index: 45} benefitRestriction: url: http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-benefitRestriction min: 0 short: Benefit Restriction (Extension) type: Extension mustSupport: true base: {max: '*', min: 0, path: DomainResource.extension} index: 46 formularyStatus: {url: 'http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-formularyStatus', min: 0, short: Formulary Status (Extension), type: Extension, mustSupport: true, index: 47} preferenceLevel: {url: 'http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-preferenceLevel', min: 0, short: Preference Level (Extension), type: Extension, mustSupport: true, index: 48} nextAvailableFillDate: {url: 'http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-nextAvailableFillDate', min: 0, short: Next Available Fill Date (Extension), type: Extension, mustSupport: true, index: 49} relatedCoverage: {url: 'http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-relatedCoverage', min: 0, short: Related Coverage (Extension), type: Extension, mustSupport: true, index: 50} elements: extension: index: 44 slicing: rules: open ordered: false discriminator: - {path: url, type: value} min: 1 slices: isAlternative: match: {url: null} schema: {short: Is Alternative (Extension), type: Extension, mustSupport: true, url: 'http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-isAlternative', index: 45} min: 1 max: 1 benefitRestriction: match: {url: null} schema: short: Benefit Restriction (Extension) type: Extension mustSupport: true url: http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-benefitRestriction base: {max: '*', min: 0, path: DomainResource.extension} index: 46 min: 0 formularyStatus: match: {url: null} schema: {short: Formulary Status (Extension), type: Extension, mustSupport: true, url: 'http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-formularyStatus', index: 47} min: 0 preferenceLevel: match: {url: null} schema: {short: Preference Level (Extension), type: Extension, mustSupport: true, url: 'http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-preferenceLevel', index: 48} min: 0 nextAvailableFillDate: match: {url: null} schema: {short: Next Available Fill Date (Extension), type: Extension, mustSupport: true, url: 'http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-nextAvailableFillDate', index: 49} min: 0 relatedCoverage: match: {url: null} schema: {short: Related Coverage (Extension), type: Extension, mustSupport: true, url: 'http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-relatedCoverage', index: 50} min: 0 itemSequence: {label: Associated request Item Sequence, short: Associated request Item Sequence, mustSupport: true, index: 51} provider: type: Reference label: Priced Pharmacy short: Priced Pharmacy mustSupport: true refers: ['http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-pharmacy-organization'] index: 52 elements: reference: {label: Reference to Priced Pharmacy, short: Reference to Priced Pharmacy, mustSupport: true, index: 53} required: [reference] productOrService: label: Product short: Product binding: {strength: extensible, valueSet: 'http://hl7.org/fhir/us/carin-rtpbc/ValueSet/rtpbc-prescribable-product-code'} mustSupport: true index: 54 elements: coding: mustSupport: true index: 55 elements: system: {mustSupport: true, index: 56} code: {mustSupport: true, index: 57} display: {label: Product Description, short: Product Description, mustSupport: true, index: 58} required: [display, system, code] required: [coding] quantity: label: Priced Quantity short: Priced Quantity mustSupport: true index: 59 elements: value: {label: Quantity in Billing Units, short: Quantity in Billing Units, mustSupport: true, index: 60} unit: label: Billing unit of measure short: Billing unit of measure binding: {strength: extensible, valueSet: 'http://hl7.org/fhir/us/carin-rtpbc/ValueSet/rtpbc-billing-unit'} mustSupport: true index: 61 required: [value, unit] noteNumber: {label: Determination Note Number, short: Determination Note Number, mustSupport: true, index: 62} adjudication: type: BackboneElement label: Alternative Product and Pharmacy Determination short: Alternative Product and Pharmacy Determination mustSupport: true index: 63 elements: category: short: Patient Pay Component mustSupport: true binding: {strength: required, valueSet: 'http://hl7.org/fhir/us/carin-rtpbc/ValueSet/rtpbc-patient-pay-type'} label: Patient Pay Component index: 64 amount: label: Patient Pay Component Amount short: Patient Pay Component Amount mustSupport: true index: 65 elements: value: {label: Patient Pay Amount Value, short: Patient Pay Amount Value, mustSupport: true, index: 66} currency: label: Patient Pay Amount Currency short: Patient Pay Amount Currency binding: {strength: required, valueSet: 'http://hl7.org/fhir/ValueSet/currencies'} mustSupport: true index: 67 required: [currency, value] required: [amount] required: [extension, quantity, itemSequence] package_version: 2.0.0-ballot class: profile kind: resource url: http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-response-claimresponse-non-phi base: http://hl7.org/fhir/StructureDefinition/ClaimResponse version: 2.0.0-ballot required: [request, identifier]