| Name | Flags | Card. | Type |
Description & Constraints
|
|---|---|---|---|---|
ClaimResponse
|
ClaimResponse | |||
id
|
S | 0.. | Unique ClaimResponse Resource Identifier | |
|
identifier
|
S | 1.. | RTPBC Response Identifier | |
value
|
S | 1.. | Unique RTPBC response ID | |
|
status
|
S | 1.. |
Response status Fixed Value: active |
|
|
type
|
S | Requested Service Type | ||
|
coding
|
S | 1..1 | ||
system
|
S | 1..1 | Fixed Value: http://terminology.hl7.org/CodeSystem/claim-type | |
|
code
|
S | 1..1 | Fixed Value: pharmacy | |
|
display
|
S | 1..1 | Fixed Value: Pharmacy | |
|
use
|
S |
Processing Mode Fixed Value: predetermination |
||
patient
|
S | Reference (RTPBC Patient) | Response Patient Information | |
|
insurer
|
S | |||
|
identifier
|
S | 1.. | ||
|
value
|
S | 1.. | Payer ID | |
|
request
|
S | 1.. | Submitter's RTPBC Request ID | |
|
identifier
|
S | 1.. | ||
|
value
|
S | 1.. | RTPBC Request ID | |
|
outcome
|
S | Processing Outcome | ||
|
disposition
|
S | Completed Note | ||
|
item
|
S | Requested Product and Pharmacy | ||
benefitRestriction
|
S | 0..* | Coding |
Benefit Restriction (Extension) URL: http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-benefitRestriction Binding: RTPBC Benefit Restriction Value Set ( extensible ) |
|
itemSequence
|
S | |||
|
noteNumber
|
S | Determination Note Number | ||
|
adjudication
|
S | Requested Product and Pharmacy Determination | ||
|
category
|
S |
Patient Pay Component Binding: RTPBC Patient Pay Type Value Set ( required ): RTPBC Patient Pay Categories |
||
|
amount
|
S | 1.. | Patient Pay Component Amount | |
|
value
|
S | 1.. | Patient Pay Amount Value | |
|
currency
|
S | 1.. |
Patient Pay Amount Currency Binding: Currencies ( required ): Currencies |
|
|
addItem
|
S | |||
|
isAlternative
|
S | 1..1 | boolean |
Is Alternative (Extension) URL: http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-isAlternative |
|
benefitRestriction
|
S | 0..* | Coding |
Benefit Restriction (Extension) URL: http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-benefitRestriction Binding: RTPBC Benefit Restriction Value Set ( extensible ) |
|
itemSequence
|
S | 1.. | Associated request Item Sequence | |
|
provider
|
S | 1.. | Reference (RTPBC Pharmacy Organization) | Priced Pharmacy |
|
reference
|
S | 1.. | Reference to Priced Pharmacy | |
|
productOrService
|
S |
Product Binding: RTPBC Prescribable Product Code Value Set ( extensible ): RTPBC prescribable product codes (NDC11 and RxNorm) |
||
|
coding
|
S | 1.. | ||
|
system
|
S | 1.. | ||
|
code
|
S | 1.. | ||
|
display
|
S | 1.. | Product Description | |
|
quantity
|
S | 1.. | Priced Quantity | |
|
value
|
S | 1.. | Quantity in Billing Units | |
|
unit
|
S | 1.. |
Billing unit of measure Binding: RTPBC Billing Unit Value Set ( extensible ): Billing quantity unit of measure |
|
|
noteNumber
|
S | Determination Note Number | ||
|
adjudication
|
S | Alternative Product and Pharmacy Determination | ||
|
category
|
S |
Patient Pay Component Binding: RTPBC Patient Pay Type Value Set ( required ): RTPBC Patient Pay Categories |
||
|
amount
|
S | 1.. | Patient Pay Component Amount | |
|
value
|
S | 1.. | Patient Pay Amount Value | |
|
currency
|
S | 1.. |
Patient Pay Amount Currency Binding: Currencies ( required ): Currencies |
|
|
processNote
|
S | Determination Note | ||
|
number
|
S | 1.. | Determination Note Number | |
|
text
|
S | 1.. | Determination Note Text | |
|
error
|
S | Error Information | ||
|
code
|
S |
Reject Reason Binding: RTPBC Error Code Value Set ( preferred ): RTPBC Error Codes |
||
|
coding
|
S | 1.. | ||
|
system
|
S | 1.. | ||
|
code
|
S | 1.. | Reject Code | |
|
display
|
S | 1.. | ||
|
text
|
S | Reject Message | ||
|
Documentation for this format
|
||||