Example RTPBC request scenario using FHIR messaging

In this example:

• the client is a patient application
• the server is the patient's insurer (specifically, the party that manages the patient's pharmacy benefit)
• the request is submitted as a Bundle containing a Claim and supporting resources, as the single parameter to the processor's $process-message operation

Content:

• the patient's name is Jane Doe, date of birth is 1975-12-05, and address is 100 Oak Court, Madison, WI 53510
• the requested medication is Prozac 10mg capsule, 60 capsules, for a 30 day supply (reflected in the Claim and MedicationRequest resources)
• the prescriber's identifying information is captured in the Practitioner resource
• the requested pharmacy is Hometown Drug (reflected in the Organization resource)
• the patient's coverage identifiers (BIN/PCN, member ID) are conveyed in a Coverage resource

The supporting data (patient, coverage, prescription, etc.) consists of identifying information that the processor will use to locate the patient's insurance record and coverage rules applying to the medication, pharmacy and prescriber.

Bundle rtpbc-bundle-request-03-w-header of type message

Entry 1 - Full URL = urn:uuid:61ebe359-bfdc-4613-8bf2-c5e300945f0a

Resource MessageHeader:

Entry 2 - Full URL = urn:uuid:61ebe359-bfdc-4613-8bf2-c5e300945f0b

Resource Claim:

Entry 3 - Full URL = urn:uuid:61ebe359-bfdc-4613-8bf2-c5e300945f0c

Resource Patient:

Entry 4 - Full URL = urn:uuid:61ebe359-bfdc-4613-8bf2-c5e300945f0d

Resource Coverage:

Entry 5 - Full URL = urn:uuid:61ebe359-bfdc-4613-8bf2-c5e300945f0e

Resource MedicationRequest:

Entry 6 - Full URL = urn:uuid:61ebe359-bfdc-4613-8bf2-c5e300945f0f

Resource Practitioner:

Entry 7 - Full URL = urn:uuid:61ebe359-bfdc-4613-8bf2-c5e300945f0g

Resource Organization: