HL7.FHIR.US.CARIN-RTPBC\RtpbcBenefitRestrictionExtension

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. For a full list of available versions, see the Directory of published versions

Extension: RtpbcExtensionBenefitRestriction

This extension conveys benefit restrictions that may apply to a prescription product and pharmacy combination.

The official URL for this extension is:

http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-benefitRestriction

Status: active
Extension maintained by: HL7 International - Pharmacy

Context of Use

This extension may be used on the following element(s):

ClaimResponse.item
ClaimResponse.addItem

This extension enables a real-time pharmacy benefit check responder to indicate one or more benefit restrictions that apply to:

the requested medication and pharmacy
an alternative medication and pharmacy

Values conveyed in this extension are defined in the RTPBC Benefit Restriction value set.

Usage info

Usage:

Use this Extension: RTPBC Response Using ClaimResponse

Formal Views of Extension Content

Description of Profiles, Differentials, Snapshots, and how the XML and JSON presentations work.

Text Summary
Differential Table
Snapshot Table
All

This structure is derived from Extension

Summary

Mandatory: 1 element
Fixed Value: 1 element
Prohibited: 1 element

Maturity: 1

This structure is derived from Extension

Name	Card.	Type	Description & Constraints
Extension	0..*	Extension	Benefit restriction.
extension	0..0
url	1..1	uri	"http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-benefitRestriction"
value[x]	1..1	Coding	Value of extension Binding: RTPBC Benefit Restriction Value Set (extensible)
Documentation for this format

Name	Flags	Card.	Type	Description & Constraints
Extension	I	0..*	Extension	Benefit restriction.
id		0..1	string	Unique id for inter-element referencing
extension	I	0..0
url		1..1	uri	"http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-benefitRestriction"
value[x]	I	1..1	Coding	Value of extension Binding: RTPBC Benefit Restriction Value Set (extensible)
Documentation for this format

This structure is derived from Extension

Summary

Mandatory: 1 element
Fixed Value: 1 element
Prohibited: 1 element

Maturity: 1

Differential View

This structure is derived from Extension

Name	Card.	Type	Description & Constraints
Extension	0..*	Extension	Benefit restriction.
extension	0..0
url	1..1	uri	"http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-benefitRestriction"
value[x]	1..1	Coding	Value of extension Binding: RTPBC Benefit Restriction Value Set (extensible)
Documentation for this format

Snapshot View

Name	Flags	Card.	Type	Description & Constraints
Extension	I	0..*	Extension	Benefit restriction.
id		0..1	string	Unique id for inter-element referencing
extension	I	0..0
url		1..1	uri	"http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-benefitRestriction"
value[x]	I	1..1	Coding	Value of extension Binding: RTPBC Benefit Restriction Value Set (extensible)
Documentation for this format

Other representations of extension: Schematron

Terminology Bindings

Path	Conformance	ValueSet
Extension.value[x]	extensible	RtbpcBenefitRestrictionValueSet

Constraints

Id	Path	Details	Requirements
ele-1	Extension	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
ext-1	Extension	Must have either extensions or value[x], not both : extension.exists() != value.exists()
ele-1	Extension.value[x]	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())