RtpbcCoverage

RTPBC Coverage

activeCARIN RTPBC1.0.0resource14 key elements

This profile constrains the Coverage resource for carrying the pharmacy benefit information required in the consumer real-time pharmacy benefit check process

Metadata

hl7.org/fhir
Canonical URL
http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-coverage
ID
rtpbc-coverage
Type
Base Definition
Derivation
constraint
Mandatory and Must-Support Elements

Elements with cardinality > 0 or marked as Must Support (S)

PathCard.TypeFlagsDescription
subscriberId
S
Health Plan Cardholder ID
beneficiary
S
payor
S
Payer ID
payor.identifier
S
Payer ID
payor.identifier.value
S1+
Payer ID Value
class0..*
S
Pharmacy coverage identifiers
:bin
S
IIN (BIN) number
class.type1..1
1+
:pcn
S
Processor Control Number (PCN)
class.type1..1
1+
:rxgroup-id
S
Pharmacy Benefit Group ID
class.type1..1
1+
:pbm-member-id
S
PBM Member ID
class.type1..1
1+