description: This profile constrains the Claim resource so that it can serve as the RTPBC Request in the consumer real-time pharmacy benefit check process
package_name: hl7.fhir.us.carin-rtpbc
derivation: constraint
name: RtpbcRequestClaim
type: Claim
elements:
  patient:
    type: Reference
    label: Request Patient Information
    short: Request Patient Information
    mustSupport: true
    refers: ['http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-patient']
    index: 10
    elements:
      reference: {label: Patient Reference, short: Patient Reference, mustSupport: true, index: 11}
    required: [reference]
  insurance:
    label: Pharmacy Coverage
    short: Pharmacy Coverage
    mustSupport: true
    index: 26
    elements:
      sequence:
        mustSupport: true
        pattern: {type: PositiveInt, value: 1}
        index: 27
      focal:
        mustSupport: true
        pattern: {type: Boolean, value: true}
        index: 28
      coverage:
        type: Reference
        label: Pharmacy Coverage Reference
        short: Pharmacy Coverage Reference
        mustSupport: true
        refers: ['http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-coverage']
        index: 29
        elements:
          reference: {label: Pharmacy Coverage Reference, short: Pharmacy Coverage Reference, mustSupport: true, index: 30}
  use:
    label: Processing Mode
    short: Processing Mode
    pattern: {type: Code, value: predetermination}
    mustSupport: true
    index: 9
  item:
    label: Max 1 item per request
    short: Max 1 item per request
    mustSupport: true
    index: 31
    elements:
      sequence:
        mustSupport: true
        pattern: {type: PositiveInt, value: 1}
        index: 32
      careTeamSequence: {short: Care Team Sequence ID Reference, mustSupport: true, label: Care Team Sequence ID Reference, index: 33}
      productOrService:
        label: Prescribed Product
        short: Prescribed Product
        binding: {strength: extensible, valueSet: 'http://hl7.org/fhir/us/carin-rtpbc/ValueSet/rtpbc-prescribable-product-code'}
        mustSupport: true
        index: 34
        elements:
          coding:
            mustSupport: true
            index: 35
            elements:
              system: {mustSupport: true, index: 36}
              code: {mustSupport: true, index: 37}
              display: {label: Product Description, short: Product Description, mustSupport: true, index: 38}
            required: [display, system, code]
        required: [coding]
      quantity:
        label: Prescribed Quantity
        short: Prescribed Quantity
        mustSupport: true
        index: 39
        elements:
          value: {label: Quantity in Billing Units, short: Quantity in Billing Units, mustSupport: true, index: 40}
          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: 41
        required: [value, unit]
    required: [quantity, careTeamSequence]
  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]
  created: {label: Created DateTime, short: Created DateTime, mustSupport: true, index: 12}
  priority:
    label: Processing priority
    short: Processing priority
    mustSupport: true
    index: 15
    elements:
      coding:
        mustSupport: true
        index: 16
        elements:
          system:
            pattern: {type: Uri, value: 'http://terminology.hl7.org/CodeSystem/processpriority'}
            mustSupport: true
            index: 17
          code:
            pattern: {type: Code, value: normal}
            mustSupport: true
            index: 18
          display:
            pattern: {type: String, value: Normal}
            mustSupport: true
            index: 19
        required: [display, system, code]
    required: [coding]
  status:
    label: Request status
    short: Request status
    pattern: {type: Code, value: active}
    mustSupport: true
    index: 3
  prescription:
    short: Prescription Reference
    index: 20
    refers: ['http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-medicationrequest']
    type: Reference
    mustSupport: true
    elements:
      reference: {mustSupport: true, index: 21}
    label: Prescription Reference
    required: [reference]
  id: {label: Unique Claim Resource Identifier, short: Unique Claim Resource Identifier, mustSupport: true, index: 0}
  identifier:
    label: RTPBC request identifier
    short: RTPBC request identifier
    mustSupport: true
    index: 1
    elements:
      value: {label: Unique RTPBC request ID, short: Unique RTPBC request ID, mustSupport: true, index: 2}
    required: [value]
  provider:
    type: Reference
    label: Preferred Pharmacy
    short: Preferred Pharmacy
    mustSupport: true
    refers: ['http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-pharmacy-organization']
    index: 13
    elements:
      reference: {label: Reference to Pharmacy Organization, short: Reference to Pharmacy Organization, mustSupport: true, index: 14}
    required: [reference]
  careTeam:
    short: Prescriber
    mustSupport: true
    label: Prescriber
    index: 22
    elements:
      sequence:
        mustSupport: true
        pattern: {type: PositiveInt, value: 1}
        index: 23
      provider:
        type: Reference
        label: Prescriber
        short: Prescriber
        mustSupport: true
        refers: ['http://hl7.org/fhir/us/core/StructureDefinition/us-core-practitioner']
        index: 24
        elements:
          reference: {label: Prescriber Reference, short: Prescriber Reference, mustSupport: true, index: 25}
        required: [reference]
package_version: 2.0.0-ballot
class: profile
kind: resource
url: http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-request-claim
base: http://hl7.org/fhir/StructureDefinition/Claim
version: 2.0.0-ballot
required: [careTeam, prescription, id, identifier, item]