HL7.FHIR.US.CARIN-RTPBC\Example RTPBC Response

This page is part of the Consumer Real-time Pharmacy Benefit Check (v1.0.0: STU 1) based on FHIR R4. This is the current published version in it's permanent home (it will always be available at this URL). For a full list of available versions, see the Directory of published versions

Example RTPBC Response

Format(s):

Example RTPBC ClaimResponse (the "RTPBC response")

In this example:

the requested medication is Prozac 10mg capsule, 60 capsules, and the requested pharmacy is Hometown Drug. Adjudication is returned in the ClaimResponse.item composite
the .item contains patient costs for the requested drug and pharmacy combination
the .addItem composite holds an alternative fulfillment (the requested drug at a different pharmacy). Adjudication is returned in the ClaimResponse.addItem composite
a referenced pharmacy Organization resource describes the alternative pharmacy option identified by the processor
benefit restriction information (e.g., Covered, Covered but requiring PA) is returned in the .benefitRestriction extensions in the .item and .addItem composites

Narrative view

Generated Narrative

id: rtpbc-claim-response-03

meta:

identifier: id: rtpbc-03-response

status: active

type: Pharmacy

use: predetermination

patient: Generated Summary: id: rtpbc-patient-03; Patient internal identifier: 30455; Jane Doe ; gender: female; birthDate: 1975-12-05

created: Nov 1, 2019 4:20:59 PM

insurer:

request:

outcome: complete

disposition: Processed successfully

item
itemSequence: 1
adjudication
category: Copay
amount:
adjudication
category: Per prescription coinsurance
amount:
adjudication
category: Total patient responsibility
amount:

addItem
itemSequence: 1
provider: Generated Summary: id: rtpbc-organization-03m; id: 0999029; active; Mail Order; name: My Mail Service Pharmacy; ph: 5551234567
productOrService: PROzac 10 MG Oral Capsule
quantity: 180 {Each}
Adjudications
- Category Amount
* Copay
* Per prescription coinsurance
* Total patient responsibility