RtpbcRequestClaim

RTPBC Request Using Claim

activeCARIN RTPBC1.0.0resource42 key elements

This profile constrains the Claim resource so that it can serve as the RTPBC Request in the consumer real-time pharmacy benefit check process

Metadata

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

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

PathCard.TypeFlagsDescription
id
S1+
Unique Claim Resource Identifier
identifier1..1
S1+
RTPBC request identifier
identifier.value
S1+
Unique RTPBC request ID
status
S
Request status
type
S
Requested Service Type
type.coding1..1
S1+
type.coding.system1..1
S1+
type.coding.code1..1
S1+
type.coding.display1..1
S1+
use
S
Processing Mode
patient
Reference
S
Request Patient Information
patient.reference1..1
S1+
Patient Reference
created
S
Created DateTime
provider
Reference
S
Preferred Pharmacy
provider.reference1..1
S1+
Reference to Pharmacy Organization
priority
S
Processing priority
priority.coding1..1
S1+
priority.coding.system1..1
S1+
priority.coding.code1..1
S1+
priority.coding.display1..1
S1+
prescription
Reference
S1+
Prescription Reference
prescription.reference
S1+
careTeam1..1
S1+
Prescriber
careTeam.sequence
S
careTeam.provider1..1
Reference
S1+
Prescriber
careTeam.provider.reference1..1
S1+
Prescriber Reference
insurance1..1
S1+
Pharmacy Coverage
insurance.sequence
S
insurance.focal
S
insurance.coverage1..1
Reference
S1+
Pharmacy Coverage Reference
insurance.coverage.reference0..1
S
Pharmacy Coverage Reference
item1..1
S1+
Max 1 item per request
item.sequence
S
item.careTeamSequence1..1
S1+
Care Team Sequence ID Reference
item.productOrService
S
Prescribed Product
item.productOrService.coding1..*
S1+
item.productOrService.coding.system
S1+
item.productOrService.coding.code
S1+
item.productOrService.coding.display
S1+
Product Description
item.quantity
S1+
Prescribed Quantity
item.quantity.value
S1+
Quantity in Billing Units
item.quantity.unit
S1+
Billing unit of measure