{
"description": "This is a guide for implementing the Consumer-Focused Real-Time Pharmacy Benefit Check (consumer RTPBC) using FHIR R4. Using RTPBC, a patient can learn the cost and insurance coverage related to medications they've been prescribed. Specifically: how a medication will be covered by their insurance, including out of pocket costs and any coverage restrictions or requirements that might apply, discount pricing available for the medication. Consumer RTPBC leverages the predetermination process supported by the Claim and ClaimResponse FHIR resources. Accompanying resources carry information that identifies the patient and their insurance coverage, prescription information and the preferred pharmacy (Patient, Coverage, MedicationRequest, Practitioner and Organization).",
"_filename": "ImplementationGuide-hl7.fhir.us.carin-rtpbc.json",
"package_name": "hl7.fhir.us.carin-rtpbc",
"definition": {
"page": {
"page": [ {
"title": "IG Home Page",
"nameUrl": "index.html",
"generation": "markdown"
}, {
"title": "Use Cases",
"nameUrl": "use_cases.html",
"generation": "markdown"
}, {
"title": "Information Content and FHIR Resources",
"nameUrl": "information_content_and_fhir_resources.html",
"generation": "markdown"
}, {
"title": "Business Rules",
"nameUrl": "business_rules.html",
"generation": "markdown"
}, {
"title": "Submission Method",
"nameUrl": "submission_method.html",
"generation": "markdown"
}, {
"title": "Error Handling",
"nameUrl": "error_handling.html",
"generation": "markdown"
}, {
"title": "Security",
"nameUrl": "security.html",
"generation": "markdown"
}, {
"title": "Consumer vs Provider RTPBC",
"nameUrl": "consumer_vs_provider_rtpbc.html",
"generation": "markdown"
}, {
"title": "Profiles and Extensions",
"nameUrl": "profiles.html",
"generation": "markdown"
}, {
"title": "Terminology",
"nameUrl": "terminology.html",
"generation": "markdown"
}, {
"title": "Capability Statements",
"nameUrl": "capstatements.html",
"generation": "markdown"
}, {
"title": "Examples",
"nameUrl": "other.html",
"generation": "markdown"
}, {
"title": "Downloads",
"nameUrl": "downloads.html",
"generation": "markdown"
} ],
"title": "Table of Contents",
"nameUrl": "toc.html",
"generation": "html"
},
"resource": [ {
"name": "RtpbcRequestClaim",
"extension": [ {
"url": "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString": "StructureDefinition:resource"
}, {
"url": "http://hl7.org/fhir/StructureDefinition/implementationguide-page",
"valueUri": "StructureDefinition-rtpbc-request-claim.html"
} ],
"reference": {
"display": "RtpbcRequestClaim",
"reference": "StructureDefinition/rtpbc-request-claim"
},
"description": "This profile constrains the Claim resource so that it can serve as the request in the consumer Real-time Pharmacy Benefit Check (RTPBC) process.",
"exampleBoolean": false
}, {
"name": "RtpbcResponseClaimResponse",
"extension": [ {
"url": "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString": "StructureDefinition:resource"
}, {
"url": "http://hl7.org/fhir/StructureDefinition/implementationguide-page",
"valueUri": "StructureDefinition-rtpbc-response-claimresponse.html"
} ],
"reference": {
"display": "RtpbcResponseClaimResponse",
"reference": "StructureDefinition/rtpbc-response-claimresponse"
},
"description": "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",
"exampleBoolean": false
}, {
"name": "RtpbcPatient",
"extension": [ {
"url": "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString": "StructureDefinition:resource"
}, {
"url": "http://hl7.org/fhir/StructureDefinition/implementationguide-page",
"valueUri": "StructureDefinition-rtpbc-patient.html"
} ],
"reference": {
"display": "RtpbcPatient",
"reference": "StructureDefinition/rtpbc-patient"
},
"description": "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.",
"exampleBoolean": false
}, {
"name": "RtpbcCoverage",
"extension": [ {
"url": "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString": "StructureDefinition:resource"
}, {
"url": "http://hl7.org/fhir/StructureDefinition/implementationguide-page",
"valueUri": "StructureDefinition-rtpbc-coverage.html"
} ],
"reference": {
"display": "RtpbcCoverage",
"reference": "StructureDefinition/rtpbc-coverage"
},
"description": "This profile constrains the Coverage resource for carrying the pharmacy benefit information required in the consumer real-time pharmacy benefit check process",
"exampleBoolean": false
}, {
"name": "RtpbcMedicationRequest",
"extension": [ {
"url": "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString": "StructureDefinition:resource"
}, {
"url": "http://hl7.org/fhir/StructureDefinition/implementationguide-page",
"valueUri": "StructureDefinition-rtpbc-medicationrequest.html"
} ],
"reference": {
"display": "RtpbcMedicationRequest",
"reference": "StructureDefinition/rtpbc-medicationrequest"
},
"description": "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",
"exampleBoolean": false
}, {
"name": "RtpbcPharmacy",
"extension": [ {
"url": "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString": "StructureDefinition:resource"
}, {
"url": "http://hl7.org/fhir/StructureDefinition/implementationguide-page",
"valueUri": "StructureDefinition-rtpbc-pharmacy-organization.html"
} ],
"reference": {
"display": "RtpbcPharmacy",
"reference": "StructureDefinition/rtpbc-pharmacy-organization"
},
"description": "This profile represents a pharmacy as used in the real-time pharmacy benefit check (RTPBC) process.",
"exampleBoolean": false
}, {
"name": "RtpbcRequestMessageHeader",
"extension": [ {
"url": "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString": "StructureDefinition:resource"
}, {
"url": "http://hl7.org/fhir/StructureDefinition/implementationguide-page",
"valueUri": "StructureDefinition-rtpbc-request-messageheader.html"
} ],
"reference": {
"display": "RtpbcRequestMessageHeader",
"reference": "StructureDefinition/rtpbc-request-messageheader"
},
"description": "This profile constrains a MessageHeader resource for use in a Real-time Pharmacy Benefit Check (RTPBC) request bundle",
"exampleBoolean": false
}, {
"name": "RtpbcResponseMessageHeader",
"extension": [ {
"url": "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString": "StructureDefinition:resource"
}, {
"url": "http://hl7.org/fhir/StructureDefinition/implementationguide-page",
"valueUri": "StructureDefinition-rtpbc-response-messageheader.html"
} ],
"reference": {
"display": "RtpbcResponseMessageHeader",
"reference": "StructureDefinition/rtpbc-response-messageheader"
},
"description": "This profile constrains a MessageHeader resource for use in a Real-time Pharmacy Benefit Check (RTPBC) response bundle",
"exampleBoolean": false
}, {
"name": "RtpbcRequestBundle",
"extension": [ {
"url": "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString": "StructureDefinition:resource"
}, {
"url": "http://hl7.org/fhir/StructureDefinition/implementationguide-page",
"valueUri": "StructureDefinition-rtpbc-request-bundle.html"
} ],
"reference": {
"display": "RtpbcRequestBundle",
"reference": "StructureDefinition/rtpbc-request-bundle"
},
"description": "This profile constrains a Bundle resource for use as the request in a Real-time Pharmacy Benefit Check (RTPBC) process",
"exampleBoolean": false
}, {
"name": "RtpbcResponseBundle",
"extension": [ {
"url": "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString": "StructureDefinition:resource"
}, {
"url": "http://hl7.org/fhir/StructureDefinition/implementationguide-page",
"valueUri": "StructureDefinition-rtpbc-response-bundle.html"
} ],
"reference": {
"display": "RtpbcResponseBundle",
"reference": "StructureDefinition/rtpbc-response-bundle"
},
"description": "This profile constrains a Bundle resource for use as the response in a Real-time Pharmacy Benefit Check (RTPBC) process",
"exampleBoolean": false
}, {
"name": "RtpbcPrescribableProductCodeValueSet",
"extension": [ {
"url": "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString": "ValueSet"
}, {
"url": "http://hl7.org/fhir/StructureDefinition/implementationguide-page",
"valueUri": "ValueSet-rtpbc-prescribable-product-code.html"
} ],
"reference": {
"display": "RtpbcPrescribableProductCodeValueSet",
"reference": "ValueSet/rtpbc-prescribable-product-code"
},
"description": "This value set includes codes used to specify prescribed medications in the US: RxNorm codes that specify drug name, strength and dose form (SBD, SCD, BPCK and GPCK term types) and NDC-11 codes (which represent specific packaged products).",
"exampleBoolean": false
}, {
"name": "RtpbcBenefitRestrictionCodeSystem",
"extension": [ {
"url": "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString": "CodeSystem"
}, {
"url": "http://hl7.org/fhir/StructureDefinition/implementationguide-page",
"valueUri": "CodeSystem-rtpbc-benefit-restriction.html"
} ],
"reference": {
"display": "RtpbcBenefitRestrictionCodeSystem",
"reference": "CodeSystem/rtpbc-benefit-restriction"
},
"description": "This code system defines a set of benefit restrictions that may apply to a prescription product and pharmacy combination evaluated in the Real-time Pharmacy Benefit Check (RTPBC) process.",
"exampleBoolean": false
}, {
"name": "RtpbcEventTypeCodeSystem",
"extension": [ {
"url": "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString": "CodeSystem"
}, {
"url": "http://hl7.org/fhir/StructureDefinition/implementationguide-page",
"valueUri": "CodeSystem-rtpbc-event-type.html"
} ],
"reference": {
"display": "RtpbcEventTypeCodeSystem",
"reference": "CodeSystem/rtpbc-event-type"
},
"description": "This code system defines event types used in RTPBC message headers",
"exampleBoolean": false
}, {
"name": "RtpbcPatientPayTypeCodeSystem",
"extension": [ {
"url": "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString": "CodeSystem"
}, {
"url": "http://hl7.org/fhir/StructureDefinition/implementationguide-page",
"valueUri": "CodeSystem-rtpbc-patient-pay-type.html"
} ],
"reference": {
"display": "RtpbcPatientPayTypeCodeSystem",
"reference": "CodeSystem/rtpbc-patient-pay-type"
},
"description": "This code system defines components of a patient's responsibility for a prescription product's cost.",
"exampleBoolean": false
}, {
"name": "RtpbcNamingSystemCanadaPostProvinceCode",
"extension": [ {
"url": "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString": "NamingSystem"
}, {
"url": "http://hl7.org/fhir/StructureDefinition/implementationguide-page",
"valueUri": "NamingSystem-rtpbc-NamingSystem-canada-post-province-code.html"
} ],
"reference": {
"display": "RtpbcNamingSystemCanadaPostProvinceCode",
"reference": "NamingSystem/rtpbc-NamingSystem-canada-post-province-code"
},
"description": "Canada Post province codes",
"exampleBoolean": false
}, {
"name": "RtpbcNamingSystemNcpdpPharmacyType",
"extension": [ {
"url": "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString": "NamingSystem"
}, {
"url": "http://hl7.org/fhir/StructureDefinition/implementationguide-page",
"valueUri": "NamingSystem-rtpbc-NamingSystem-ncpdp-pharmacy-type.html"
} ],
"reference": {
"display": "RtpbcNamingSystemNcpdpPharmacyType",
"reference": "NamingSystem/rtpbc-NamingSystem-ncpdp-pharmacy-type"
},
"description": "The NCPDP Pharmacy Type (955-HR) code set defines a set of pharmacy type categories.",
"exampleBoolean": false
}, {
"name": "RtpbcNamingSystemNcpdpId",
"extension": [ {
"url": "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString": "NamingSystem"
}, {
"url": "http://hl7.org/fhir/StructureDefinition/implementationguide-page",
"valueUri": "NamingSystem-rtpbc-NamingSystem-ncpdp-provider-id.html"
} ],
"reference": {
"display": "RtpbcNamingSystemNcpdpId",
"reference": "NamingSystem/rtpbc-NamingSystem-ncpdp-provider-id"
},
"description": "The NCPDP Pharmacy Type (955-HR) code set defines a set of pharmacy type categories.",
"exampleBoolean": false
}, {
"name": "RtpbcNamingSystemNcpdpRejectCode",
"extension": [ {
"url": "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString": "NamingSystem"
}, {
"url": "http://hl7.org/fhir/StructureDefinition/implementationguide-page",
"valueUri": "NamingSystem-rtpbc-NamingSystem-ncpdp-reject-code.html"
} ],
"reference": {
"display": "RtpbcNamingSystemNcpdpRejectCode",
"reference": "NamingSystem/rtpbc-NamingSystem-ncpdp-reject-code"
},
"description": "The NCPDP Reject Code (511-FB) code set contains exception definitions for use when transaction processing cannot be completed.",
"exampleBoolean": false
}, {
"name": "RtbpcBillingUnitValueSet",
"extension": [ {
"url": "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString": "ValueSet"
}, {
"url": "http://hl7.org/fhir/StructureDefinition/implementationguide-page",
"valueUri": "ValueSet-rtpbc-billing-unit.html"
} ],
"reference": {
"display": "RtbpcBillingUnitValueSet",
"reference": "ValueSet/rtpbc-billing-unit"
},
"description": "This value set contains the quantity unit of measure to be used when requesting predetermination of benefits for prescription-related products",
"exampleBoolean": false
}, {
"name": "RtpbcErrorCodeValueSet",
"extension": [ {
"url": "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString": "ValueSet"
}, {
"url": "http://hl7.org/fhir/StructureDefinition/implementationguide-page",
"valueUri": "ValueSet-rtpbc-error-code.html"
} ],
"reference": {
"display": "RtpbcErrorCodeValueSet",
"reference": "ValueSet/rtpbc-error-code"
},
"description": "This value set contains the error codes to be used by real-time pharmacy benefit check servers when encountering a data or business condition that prevents processing from completing. Values are defined in the NCPDP-maintained Reject Code (511-FB) code set.",
"exampleBoolean": false
}, {
"name": "RtbpcEventTypeValueSet",
"extension": [ {
"url": "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString": "ValueSet"
}, {
"url": "http://hl7.org/fhir/StructureDefinition/implementationguide-page",
"valueUri": "ValueSet-rtpbc-event-type.html"
} ],
"reference": {
"display": "RtbpcEventTypeValueSet",
"reference": "ValueSet/rtpbc-event-type"
},
"description": "This value set contains event types used in RTPBC message headers.",
"exampleBoolean": false
}, {
"name": "RtpbcCountryCodeValueSet",
"extension": [ {
"url": "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString": "ValueSet"
}, {
"url": "http://hl7.org/fhir/StructureDefinition/implementationguide-page",
"valueUri": "ValueSet-rtpbc-country-code.html"
} ],
"reference": {
"display": "RtpbcCountryCodeValueSet",
"reference": "ValueSet/rtpbc-country-code"
},
"description": "This value set contains a subset of two-letter ISO 3166-1-2 country codes for the countries in which this profile is intended to be used (US and CA).",
"exampleBoolean": false
}, {
"name": "RtbpcBenefitRestrictionValueSet",
"extension": [ {
"url": "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString": "ValueSet"
}, {
"url": "http://hl7.org/fhir/StructureDefinition/implementationguide-page",
"valueUri": "ValueSet-rtpbc-benefit-restriction.html"
} ],
"reference": {
"display": "RtbpcBenefitRestrictionValueSet",
"reference": "ValueSet/rtpbc-benefit-restriction"
},
"description": "This value set contains a set of benefit restrictions that may apply to a prescription product and pharmacy combination evaluated in the Real-time Pharmacy Benefit Check (RTPBC) process.",
"exampleBoolean": false
}, {
"name": "RtbpcPatientPayTypeValueSet",
"extension": [ {
"url": "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString": "ValueSet"
}, {
"url": "http://hl7.org/fhir/StructureDefinition/implementationguide-page",
"valueUri": "ValueSet-rtpbc-patient-pay-type.html"
} ],
"reference": {
"display": "RtbpcPatientPayTypeValueSet",
"reference": "ValueSet/rtpbc-patient-pay-type"
},
"description": "This value set contains components of a patient's responsibility for a prescription product's cost.",
"exampleBoolean": false
}, {
"name": "RtbpcPharmacyTypeValueSet",
"extension": [ {
"url": "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString": "ValueSet"
}, {
"url": "http://hl7.org/fhir/StructureDefinition/implementationguide-page",
"valueUri": "ValueSet-rtpbc-pharmacy-type.html"
} ],
"reference": {
"display": "RtbpcPharmacyTypeValueSet",
"reference": "ValueSet/rtpbc-pharmacy-type"
},
"description": "This value set contains pharmacy type categories defined in the NCPDP Pharmacy Type (955-HR) code system.",
"exampleBoolean": false
}, {
"name": "RtbpcStateAndProvinceCodeValueSet",
"extension": [ {
"url": "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString": "ValueSet"
}, {
"url": "http://hl7.org/fhir/StructureDefinition/implementationguide-page",
"valueUri": "ValueSet-rtpbc-state-and-province-code.html"
} ],
"reference": {
"display": "RtbpcStateAndProvinceCodeValueSet",
"reference": "ValueSet/rtpbc-state-and-province-code"
},
"description": "This value set contains two letter USPS state codes and Canada Post province codes.",
"exampleBoolean": false
}, {
"name": "RtpbcIsAlternativeExtension",
"extension": [ {
"url": "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString": "StructureDefinition:extension"
}, {
"url": "http://hl7.org/fhir/StructureDefinition/implementationguide-page",
"valueUri": "StructureDefinition-rtpbc-isAlternative.html"
} ],
"reference": {
"display": "RtpbcIsAlternativeExtension",
"reference": "StructureDefinition/rtpbc-isAlternative"
},
"description": "This extension indicates that this added line item is to be interpreted as one of possibly multiple alternatives to the requested product or service. When isAlternative is true, the added line item is to be considered independently from any other added line items associated with the requested product or service.",
"exampleBoolean": false
}, {
"name": "RtpbcBenefitRestrictionExtension",
"extension": [ {
"url": "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString": "StructureDefinition:extension"
}, {
"url": "http://hl7.org/fhir/StructureDefinition/implementationguide-page",
"valueUri": "StructureDefinition-rtpbc-benefitRestriction.html"
} ],
"reference": {
"display": "RtpbcBenefitRestrictionExtension",
"reference": "StructureDefinition/rtpbc-benefitRestriction"
},
"description": "This extension conveys benefit restrictions that may apply to a prescription product and pharmacy combination.",
"exampleBoolean": false
}, {
"name": "RtpbcRequestMessageDefinition",
"extension": [ {
"url": "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString": "MessageDefinition"
}, {
"url": "http://hl7.org/fhir/StructureDefinition/implementationguide-page",
"valueUri": "MessageDefinition-rtpbc-request.html"
} ],
"reference": {
"display": "RtpbcRequestMessageDefinition",
"reference": "MessageDefinition/rtpbc-request"
},
"description": "Request for patient cost and coverage information for a prescribed medication",
"exampleBoolean": false
}, {
"name": "RtpbcResponseMessageDefinition",
"extension": [ {
"url": "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString": "MessageDefinition"
}, {
"url": "http://hl7.org/fhir/StructureDefinition/implementationguide-page",
"valueUri": "MessageDefinition-rtpbc-response.html"
} ],
"reference": {
"display": "RtpbcResponseMessageDefinition",
"reference": "MessageDefinition/rtpbc-response"
},
"description": "Response to a request for patient cost and coverage information for a prescribed medication",
"exampleBoolean": false
}, {
"name": "RtpbcRequesterCapabilityStatement",
"extension": [ {
"url": "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString": "CapabilityStatement"
}, {
"url": "http://hl7.org/fhir/StructureDefinition/implementationguide-page",
"valueUri": "CapabilityStatement-rtpbc-requester.html"
} ],
"reference": {
"display": "RtpbcRequesterCapabilityStatement",
"reference": "CapabilityStatement/rtpbc-requester"
},
"description": "This CapabilityStatement describes the expected capabilities of a server that is capable of responding to a Real-time Pharmacy Benefit Check (RTPBC) request transacted with the `$process-message` operation.",
"exampleBoolean": false
}, {
"name": "RtpbcResponderCapabilityStatement",
"extension": [ {
"url": "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString": "CapabilityStatement"
}, {
"url": "http://hl7.org/fhir/StructureDefinition/implementationguide-page",
"valueUri": "CapabilityStatement-rtpbc-responder.html"
} ],
"reference": {
"display": "RtpbcResponderCapabilityStatement",
"reference": "CapabilityStatement/rtpbc-responder"
},
"description": "This CapabilityStatement describes the expected capabilities of a server that is capable of responding to a Real-time Pharmacy Benefit Check (RTPBC) request transacted with the `$process-message` operation.",
"exampleBoolean": false
}, {
"name": "Example RTPBC Request (Claim)",
"extension": [ {
"url": "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString": "Claim"
}, {
"url": "http://hl7.org/fhir/StructureDefinition/implementationguide-page",
"valueUri": "Claim-rtpbc-claim-03.html"
} ],
"reference": {
"display": "rtpbc-claim-03",
"reference": "Claim/rtpbc-claim-03"
},
"description": "Example of a consumer RTPBC Claim resource.",
"exampleCanonical": "http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-request-claim"
}, {
"name": "RTPBC Request to a Pricing Source",
"extension": [ {
"url": "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString": "Claim"
}, {
"url": "http://hl7.org/fhir/StructureDefinition/implementationguide-page",
"valueUri": "Claim-rtpbc-claim-03-price-source.html"
} ],
"reference": {
"display": "rtpbc-claim-03-price-source",
"reference": "Claim/rtpbc-claim-03-price-source"
},
"description": "Example of a consumer RTPBC Claim resource submitted to a pricing source.",
"exampleCanonical": "http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-request-claim"
}, {
"name": "Example RTPBC Response",
"extension": [ {
"url": "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString": "ClaimResponse"
}, {
"url": "http://hl7.org/fhir/StructureDefinition/implementationguide-page",
"valueUri": "ClaimResponse-rtpbc-claim-response-03.html"
} ],
"reference": {
"display": "rtpbc-claim-response-03",
"reference": "ClaimResponse/rtpbc-claim-response-03"
},
"description": "Example of a consumer RTPBC ClaimResponse resource.",
"exampleCanonical": "http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-response-claimresponse"
}, {
"name": "Example RTPBC Response - not covered",
"extension": [ {
"url": "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString": "ClaimResponse"
}, {
"url": "http://hl7.org/fhir/StructureDefinition/implementationguide-page",
"valueUri": "ClaimResponse-rtpbc-claim-response-not-covered.html"
} ],
"reference": {
"display": "rtpbc-claim-response-not-covered",
"reference": "ClaimResponse/rtpbc-claim-response-not-covered"
},
"description": "Example of a consumer RTPBC ClaimResponse resource when the requested drug is not covered.",
"exampleCanonical": "http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-response-claimresponse"
}, {
"name": "RTPBC Response from a pricing source",
"extension": [ {
"url": "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString": "ClaimResponse"
}, {
"url": "http://hl7.org/fhir/StructureDefinition/implementationguide-page",
"valueUri": "ClaimResponse-rtpbc-claim-response-03-price-source.html"
} ],
"reference": {
"display": "rtpbc-claim-response-03-price-source",
"reference": "ClaimResponse/rtpbc-claim-response-03-price-source"
},
"description": "Example of a consumer RTPBC ClaimResponse resource from a pricing source.",
"exampleCanonical": "http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-response-claimresponse"
}, {
"name": "Example RTPBC Patient",
"extension": [ {
"url": "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString": "Patient"
}, {
"url": "http://hl7.org/fhir/StructureDefinition/implementationguide-page",
"valueUri": "Patient-rtpbc-patient-03.html"
} ],
"reference": {
"display": "rtpbc-patient-03",
"reference": "Patient/rtpbc-patient-03"
},
"description": "Example of a consumer RTPBC Patient resource.",
"exampleCanonical": "http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-patient"
}, {
"name": "Example RTPBC Coverage",
"extension": [ {
"url": "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString": "Coverage"
}, {
"url": "http://hl7.org/fhir/StructureDefinition/implementationguide-page",
"valueUri": "Coverage-rtpbc-coverage-03.html"
} ],
"reference": {
"display": "rtpbc-coverage-03",
"reference": "Coverage/rtpbc-coverage-03"
},
"description": "Example of a consumer RTPBC Coverage resource.",
"exampleCanonical": "http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-coverage"
}, {
"name": "Example RTPBC MedicationRequest",
"extension": [ {
"url": "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString": "MedicationRequest"
}, {
"url": "http://hl7.org/fhir/StructureDefinition/implementationguide-page",
"valueUri": "MedicationRequest-rtpbc-medicationrequest-03.html"
} ],
"reference": {
"display": "rtpbc-medicationrequest-03",
"reference": "MedicationRequest/rtpbc-medicationrequest-03"
},
"description": "Example of a consumer RTPBC MedicationRequest resource.",
"exampleCanonical": "http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-medicationrequest"
}, {
"name": "Example RTPBC Pharmacy Organization - Hometown Drug",
"extension": [ {
"url": "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString": "Organization"
}, {
"url": "http://hl7.org/fhir/StructureDefinition/implementationguide-page",
"valueUri": "Organization-rtpbc-organization-03.html"
} ],
"reference": {
"display": "rtpbc-organization-03",
"reference": "Organization/rtpbc-organization-03"
},
"description": "Example of a consumer RTPBC pharmacy Organization resource.",
"exampleCanonical": "http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-pharmacy-organization"
}, {
"name": "Example RTPBC Pharmacy Organization - My Mail Service Pharmacy",
"extension": [ {
"url": "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString": "Organization"
}, {
"url": "http://hl7.org/fhir/StructureDefinition/implementationguide-page",
"valueUri": "Organization-rtpbc-organization-03m.html"
} ],
"reference": {
"display": "rtpbc-organization-03m",
"reference": "Organization/rtpbc-organization-03m"
},
"description": "Example of a consumer RTPBC pharmacy Organization resource.",
"exampleCanonical": "http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-pharmacy-organization"
}, {
"name": "Example US Core Practitioner as used in RTPBC",
"extension": [ {
"url": "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString": "Practitioner"
}, {
"url": "http://hl7.org/fhir/StructureDefinition/implementationguide-page",
"valueUri": "Practitioner-rtpbc-practitioner-03.html"
} ],
"reference": {
"display": "rtpbc-practitioner-03",
"reference": "Practitioner/rtpbc-practitioner-03"
},
"description": "Example of a US Core Practitioner resource representing a prescriber in the RTPBC exchange."
}, {
"name": "Example RTPBC Request MessageHeader",
"extension": [ {
"url": "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString": "MessageHeader"
}, {
"url": "http://hl7.org/fhir/StructureDefinition/implementationguide-page",
"valueUri": "MessageHeader-rtpbc-request-message-header-01.html"
} ],
"reference": {
"display": "rtpbc-request-message-header-01",
"reference": "MessageHeader/rtpbc-request-message-header-01"
},
"description": "Example of a consumer RTPBC request MessageHeader resource.",
"exampleCanonical": "http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-request-messageheader"
}, {
"name": "Example RTPBC Response MessageHeader",
"extension": [ {
"url": "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString": "MessageHeader"
}, {
"url": "http://hl7.org/fhir/StructureDefinition/implementationguide-page",
"valueUri": "MessageHeader-rtpbc-response-message-header-01.html"
} ],
"reference": {
"display": "rtpbc-response-message-header-01",
"reference": "MessageHeader/rtpbc-response-message-header-01"
},
"description": "Example of a consumer RTPBC response MessageHeader resource.",
"exampleCanonical": "http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-response-messageheader"
}, {
"name": "Example RTPBC Request Bundle",
"extension": [ {
"url": "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString": "Bundle"
}, {
"url": "http://hl7.org/fhir/StructureDefinition/implementationguide-page",
"valueUri": "Bundle-rtpbc-bundle-request-03-w-header.html"
} ],
"reference": {
"display": "rtpbc-bundle-request-03-w-header",
"reference": "Bundle/rtpbc-bundle-request-03-w-header"
},
"description": "Example of a consumer RTPBC request Bundle resource.",
"exampleCanonical": "http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-request-bundle"
}, {
"name": "RTPBC Request Bundle submitted to a pricing source",
"extension": [ {
"url": "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString": "Bundle"
}, {
"url": "http://hl7.org/fhir/StructureDefinition/implementationguide-page",
"valueUri": "Bundle-rtpbc-bundle-request-03-price-source.html"
} ],
"reference": {
"display": "rtpbc-bundle-request-03-price-source",
"reference": "Bundle/rtpbc-bundle-request-03-price-source"
},
"description": "Example of a consumer RTPBC request Bundle resource submitted to a pricing source.",
"exampleCanonical": "http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-request-bundle"
}, {
"name": "Example RTPBC Response Bundle",
"extension": [ {
"url": "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString": "Bundle"
}, {
"url": "http://hl7.org/fhir/StructureDefinition/implementationguide-page",
"valueUri": "Bundle-rtpbc-bundle-response-03-w-header.html"
} ],
"reference": {
"display": "rtpbc-bundle-response-03-w-header",
"reference": "Bundle/rtpbc-bundle-response-03-w-header"
},
"description": "Example of a consumer RTPBC response Bundle resource.",
"exampleCanonical": "http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-response-bundle"
}, {
"name": "RTPBC Response Bundle returned by a pricing source",
"extension": [ {
"url": "http://hl7.org/fhir/tools/StructureDefinition/resource-information",
"valueString": "Bundle"
}, {
"url": "http://hl7.org/fhir/StructureDefinition/implementationguide-page",
"valueUri": "Bundle-rtpbc-bundle-response-03-price-source.html"
} ],
"reference": {
"display": "rtpbc-bundle-response-03-price-source",
"reference": "Bundle/rtpbc-bundle-response-03-price-source"
},
"description": "Example of a consumer RTPBC response Bundle resource returned by a pricing source.",
"exampleCanonical": "http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-response-bundle"
} ],
"extension": [ {
"url": "http://hl7.org/fhir/tools/StructureDefinition/ig-parameter",
"extension": [ {
"url": "code",
"valueString": "copyrightyear"
}, {
"url": "value",
"valueString": "2020+"
} ]
}, {
"url": "http://hl7.org/fhir/tools/StructureDefinition/ig-parameter",
"extension": [ {
"url": "code",
"valueString": "releaselabel"
}, {
"url": "value",
"valueString": "STU1"
} ]
}, {
"url": "http://hl7.org/fhir/tools/StructureDefinition/ig-parameter",
"extension": [ {
"url": "code",
"valueString": "path-liquid"
}, {
"url": "value",
"valueString": "template/liquid"
} ]
}, {
"url": "http://hl7.org/fhir/tools/StructureDefinition/ig-parameter",
"extension": [ {
"url": "code",
"valueString": "path-liquid"
}, {
"url": "value",
"valueString": "input/liquid"
} ]
}, {
"url": "http://hl7.org/fhir/tools/StructureDefinition/ig-parameter",
"extension": [ {
"url": "code",
"valueString": "path-qa"
}, {
"url": "value",
"valueString": "temp/qa"
} ]
}, {
"url": "http://hl7.org/fhir/tools/StructureDefinition/ig-parameter",
"extension": [ {
"url": "code",
"valueString": "path-temp"
}, {
"url": "value",
"valueString": "temp/pages"
} ]
}, {
"url": "http://hl7.org/fhir/tools/StructureDefinition/ig-parameter",
"extension": [ {
"url": "code",
"valueString": "path-output"
}, {
"url": "value",
"valueString": "output"
} ]
}, {
"url": "http://hl7.org/fhir/tools/StructureDefinition/ig-parameter",
"extension": [ {
"url": "code",
"valueString": "path-suppressed-warnings"
}, {
"url": "value",
"valueString": "input/ignoreWarnings.txt"
} ]
}, {
"url": "http://hl7.org/fhir/tools/StructureDefinition/ig-parameter",
"extension": [ {
"url": "code",
"valueString": "path-history"
}, {
"url": "value",
"valueString": "http://hl7.org/fhir/us/carin-rtpbc/history.html"
} ]
}, {
"url": "http://hl7.org/fhir/tools/StructureDefinition/ig-parameter",
"extension": [ {
"url": "code",
"valueString": "template-html"
}, {
"url": "value",
"valueString": "template-page.html"
} ]
}, {
"url": "http://hl7.org/fhir/tools/StructureDefinition/ig-parameter",
"extension": [ {
"url": "code",
"valueString": "template-md"
}, {
"url": "value",
"valueString": "template-page-md.html"
} ]
}, {
"url": "http://hl7.org/fhir/tools/StructureDefinition/ig-parameter",
"extension": [ {
"url": "code",
"valueString": "apply-contact"
}, {
"url": "value",
"valueString": "true"
} ]
}, {
"url": "http://hl7.org/fhir/tools/StructureDefinition/ig-parameter",
"extension": [ {
"url": "code",
"valueString": "apply-context"
}, {
"url": "value",
"valueString": "true"
} ]
}, {
"url": "http://hl7.org/fhir/tools/StructureDefinition/ig-parameter",
"extension": [ {
"url": "code",
"valueString": "apply-copyright"
}, {
"url": "value",
"valueString": "true"
} ]
}, {
"url": "http://hl7.org/fhir/tools/StructureDefinition/ig-parameter",
"extension": [ {
"url": "code",
"valueString": "apply-jurisdiction"
}, {
"url": "value",
"valueString": "true"
} ]
}, {
"url": "http://hl7.org/fhir/tools/StructureDefinition/ig-parameter",
"extension": [ {
"url": "code",
"valueString": "apply-license"
}, {
"url": "value",
"valueString": "true"
} ]
}, {
"url": "http://hl7.org/fhir/tools/StructureDefinition/ig-parameter",
"extension": [ {
"url": "code",
"valueString": "apply-publisher"
}, {
"url": "value",
"valueString": "true"
} ]
}, {
"url": "http://hl7.org/fhir/tools/StructureDefinition/ig-parameter",
"extension": [ {
"url": "code",
"valueString": "apply-version"
}, {
"url": "value",
"valueString": "true"
} ]
}, {
"url": "http://hl7.org/fhir/tools/StructureDefinition/ig-parameter",
"extension": [ {
"url": "code",
"valueString": "active-tables"
}, {
"url": "value",
"valueString": "true"
} ]
} ],
"parameter": [ {
"code": "path-resource",
"value": "input/capabilities"
}, {
"code": "path-resource",
"value": "input/examples"
}, {
"code": "path-resource",
"value": "input/extensions"
}, {
"code": "path-resource",
"value": "input/models"
}, {
"code": "path-resource",
"value": "input/operations"
}, {
"code": "path-resource",
"value": "input/profiles"
}, {
"code": "path-resource",
"value": "input/resources"
}, {
"code": "path-resource",
"value": "input/vocabulary"
}, {
"code": "path-resource",
"value": "input/maps"
}, {
"code": "path-resource",
"value": "input/testing"
}, {
"code": "path-resource",
"value": "input/history"
}, {
"code": "path-pages",
"value": "template/config"
}, {
"code": "path-pages",
"value": "input/images"
}, {
"code": "path-tx-cache",
"value": "input-cache/txcache"
} ]
},
"date": "2020-08-25T19:55:16+00:00",
"meta": {
"lastUpdated": "2020-06-22T05:00:00.000+00:00"
},
"publisher": "HL7 International - Pharmacy",
"fhirVersion": [ "4.0.1" ],
"license": "CC0-1.0",
"jurisdiction": [ {
"coding": [ {
"code": "US",
"system": "urn:iso:std:iso:3166",
"display": "United States of America"
} ]
} ],
"dependsOn": [ {
"uri": "http://hl7.org/fhir/us/core/ImplementationGuide/hl7.fhir.us.core",
"version": "3.1.0",
"packageId": "hl7.fhir.us.core"
} ],
"name": "CarinRtpbc",
"type": null,
"experimental": null,
"resourceType": "ImplementationGuide",
"title": "Consumer Real-Time Pharmacy Benefit Check",
"package_version": "1.0.0",
"status": "draft",
"id": "823fbc48-f769-4d88-98f3-5b8463c4318f",
"kind": null,
"url": "http://hl7.org/fhir/us/carin-rtpbc/ImplementationGuide/hl7.fhir.us.carin-rtpbc",
"version": "1.0.0",
"packageId": "hl7.fhir.us.carin-rtpbc",
"contact": [ {
"name": "HL7 International - Pharmacy",
"telecom": [ {
"value": "http://www.hl7.org/Special/committees/medication",
"system": "url"
} ]
}, {
"name": "Frank McKinney",
"telecom": [ {
"value": "frank.mckinney@pocp.com",
"system": "email"
} ]
} ]
}