| id | | | S | Unique ClaimResponse Resource Identifier |
| identifier | | | S1+ | RTPBC Response Identifier |
| identifier.value | | | S1+ | Unique RTPBC response ID |
| status | | | S1+ | Response status |
| type | | | S | Requested Service Type |
| type.coding | 1..1 | | S1+ | |
| type.coding.system | 1..1 | | S1+ | |
| type.coding.code | 1..1 | | S1+ | |
| type.coding.display | 1..1 | | S1+ | |
| use | | | S | Processing Mode |
| patient | | Reference | S | Response Patient Information |
| insurer | | | S | |
| insurer.identifier | | | S1+ | |
| insurer.identifier.value | | | S1+ | Payer ID |
| request | | | S1+ | Submitter's RTPBC Request ID |
| request.identifier | | | S1+ | |
| request.identifier.value | | | S1+ | RTPBC Request ID |
| outcome | | | S | Processing Outcome |
| disposition | | | S | Completed Note |
| item | | | S | Requested Product and Pharmacy |
| :benefitRestriction | 0..* | Extension | S | Benefit Restriction (Extension) |
| item.itemSequence | | | S | Indicates that the information in this .item composite relates to the requested product and pharmacy. |
| item.noteNumber | | | S | Determination Note Number |
| item.adjudication | | | S | Requested Product and Pharmacy Determination |
| item.adjudication.category | | | S | Patient Pay Component |
| item.adjudication.amount | | | S1+ | Patient Pay Component Amount |
| item.adjudication.amount.value | | | S1+ | Patient Pay Amount Value |
| item.adjudication.amount.currency | | | S1+ | Patient Pay Amount Currency |
| addItem | | | S | |
| :isAlternative | 1..1 | Extension | S1+ | Is Alternative (Extension) |
| :benefitRestriction | 0..* | Extension | S | Benefit Restriction (Extension) |
| addItem.itemSequence | | | S1+ | Associated request Item Sequence |
| addItem.provider | | Reference | S1+ | Priced Pharmacy |
| addItem.provider.reference | | | S1+ | Reference to Priced Pharmacy |
| addItem.productOrService | | | S | Product |
| addItem.productOrService.coding | | | S1+ | |
| addItem.productOrService.coding.system | | | S1+ | |
| addItem.productOrService.coding.code | | | S1+ | |
| addItem.productOrService.coding.display | | | S1+ | Product Description |
| addItem.quantity | | | S1+ | Priced Quantity |
| addItem.quantity.value | | | S1+ | Quantity in Billing Units |
| addItem.quantity.unit | | | S1+ | Billing unit of measure |
| addItem.noteNumber | | | S | Determination Note Number |
| addItem.adjudication | | | S | Alternative Product and Pharmacy Determination |
| addItem.adjudication.category | | | S | Patient Pay Component |
| addItem.adjudication.amount | | | S1+ | Patient Pay Component Amount |
| addItem.adjudication.amount.value | | | S1+ | Patient Pay Amount Value |
| addItem.adjudication.amount.currency | | | S1+ | Patient Pay Amount Currency |
| processNote | | | S | Determination Note |
| processNote.number | | | S1+ | Determination Note Number |
| processNote.text | | | S1+ | Determination Note Text |
| error | | | S | Error Information |
| error.code | | | S | Reject Reason |
| error.code.coding | | | S1+ | |
| error.code.coding.system | | | S1+ | |
| error.code.coding.code | | | S1+ | Reject Code |
| error.code.coding.display | | | S1+ | |
| error.code.text | | | S | Reject Message |