FHIR IG analytics| Package | hl7.fhir.us.carin-rtpbc |
| Resource Type | Bundle |
| Id | Bundle-rtpbc-bundle-response-discount-card.json |
| FHIR Version | R4 |
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No resources found
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FHIR
FHIRsmith{
"resourceType": "Bundle",
"id": "rtpbc-bundle-response-discount-card",
"meta": {
"profile": [
"http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-response-bundle-non-phi"
]
},
"language": "en",
"type": "message",
"timestamp": "2025-11-15T13:10:13-05:00",
"entry": [
{
"fullUrl": "http://example.org/my-app/MessageHeader/rtpbc-messageheader-response-discount-card",
"resource": {
"resourceType": "MessageHeader",
"id": "rtpbc-messageheader-response-discount-card",
"meta": {
"profile": [
"http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-response-messageheader-non-phi"
]
},
"text": {
"status": "generated",
"div": "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"MessageHeader_rtpbc-messageheader-response-discount-card\"> </a><p class=\"res-header-id\"><b>Generated Narrative: MessageHeader rtpbc-messageheader-response-discount-card</b></p><a name=\"rtpbc-messageheader-response-discount-card\"> </a><a name=\"hcrtpbc-messageheader-response-discount-card\"> </a><div style=\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\"><p style=\"margin-bottom: 0px\"/><p style=\"margin-bottom: 0px\">Profile: <a href=\"StructureDefinition-rtpbc-response-messageheader-non-phi.html\">RTPBC Non-PHI Response MessageHeader</a></p></div><p><b>event</b>: <a href=\"CodeSystem-rtpbc-event-type.html#rtpbc-event-type-rtpbc-response-non-phi\">RTPBC Event Type Code System: rtpbc-response-non-phi</a> (RTPBC Non-PHI Response)</p><h3>Sources</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Name</b></td><td><b>Endpoint</b></td></tr><tr><td style=\"display: none\">*</td><td>GoodPricing</td><td><a href=\"http://example.org/GoodPricing/fhir\">http://example.org/GoodPricing/fhir</a></td></tr></table><h3>Responses</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Identifier</b></td><td><b>Code</b></td></tr><tr><td style=\"display: none\">*</td><td>rtpbc-messageheader-request-non-phi-1</td><td>OK</td></tr></table><p><b>focus</b>: <a href=\"Bundle-rtpbc-bundle-response-discount-card.html#http-//example.org/my-app/ClaimResponse/rtpbc-claim-response-discount-card\">ClaimResponse: identifier = rtpbc-03-response-discount-card; status = active; type = Pharmacy; use = predetermination; created = 2025-11-15 13:10:13-0500; outcome = complete; disposition = Processed successfully</a></p><p><b>definition</b>: <a href=\"MessageDefinition-rtpbc-response-non-phi.html\">RTPBC Non-PHI Response Message Definition</a></p></div>"
},
"eventCoding": {
"system": "http://hl7.org/fhir/us/carin-rtpbc/CodeSystem/rtpbc-event-type",
"code": "rtpbc-response-non-phi",
"display": "RTPBC Non-PHI Response"
},
"source": {
"name": "GoodPricing",
"endpoint": "http://example.org/GoodPricing/fhir"
},
"response": {
"identifier": "rtpbc-messageheader-request-non-phi-1",
"code": "ok"
},
"focus": [
{
"reference": "http://example.org/my-app/ClaimResponse/rtpbc-claim-response-discount-card"
}
],
"definition": "http://hl7.org/fhir/us/carin-rtpbc/MessageDefinition/rtpbc-response-non-phi"
}
},
{
"fullUrl": "http://example.org/my-app/ClaimResponse/rtpbc-claim-response-discount-card",
"resource": {
"resourceType": "ClaimResponse",
"id": "rtpbc-claim-response-discount-card",
"meta": {
"profile": [
"http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-response-claimresponse-non-phi"
]
},
"text": {
"status": "extensions",
"div": "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"ClaimResponse_rtpbc-claim-response-discount-card\"> </a><p class=\"res-header-id\"><b>Generated Narrative: ClaimResponse rtpbc-claim-response-discount-card</b></p><a name=\"rtpbc-claim-response-discount-card\"> </a><a name=\"hcrtpbc-claim-response-discount-card\"> </a><div style=\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\"><p style=\"margin-bottom: 0px\"/><p style=\"margin-bottom: 0px\">Profile: <a href=\"StructureDefinition-rtpbc-response-claimresponse-non-phi.html\">RTPBC Non-PHI Response Using ClaimResponse</a></p></div><p><b>identifier</b>: rtpbc-03-response-discount-card</p><p><b>status</b>: Active</p><p><b>type</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/claim-type pharmacy}\">Pharmacy</span></p><p><b>use</b>: Predetermination</p><p><b>patient</b>: ?rref?</p><p><b>created</b>: 2025-11-15 13:10:13-0500</p><p><b>insurer</b>: ?rref?</p><p><b>request</b>: Identifier: rtpbc-01</p><p><b>outcome</b>: Processing Complete</p><p><b>disposition</b>: Processed successfully</p><blockquote><p><b>item</b></p><p><b>RTPBC relatedCoverage Extension</b>: <a href=\"Coverage-rtpbc-coverage-non-phi-01.html\">Coverage: status = active; subscriberId = ; relationship = Self</a></p><p><b>itemSequence</b>: 1</p><p><b>noteNumber</b>: 1</p><blockquote><p><b>adjudication</b></p><p><b>category</b>: <span title=\"Codes:{http://hl7.org/fhir/us/carin-rtpbc/CodeSystem/rtpbc-patient-pay-type-temporary cash-price}\">Full product cash price</span></p><h3>Amounts</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style=\"display: none\">*</td><td>105</td><td>United States dollar</td></tr></table></blockquote><blockquote><p><b>adjudication</b></p><p><b>category</b>: <span title=\"Codes:{http://hl7.org/fhir/us/carin-rtpbc/CodeSystem/rtpbc-patient-pay-type-temporary coupon-discount}\">Coupon discount amount</span></p><h3>Amounts</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style=\"display: none\">*</td><td>-20</td><td>United States dollar</td></tr></table></blockquote><blockquote><p><b>adjudication</b></p><p><b>category</b>: <span title=\"Codes:{http://hl7.org/fhir/us/carin-rtpbc/CodeSystem/rtpbc-patient-pay-type-temporary total}\">Total patient responsibility</span></p><h3>Amounts</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style=\"display: none\">*</td><td>85</td><td>United States dollar</td></tr></table></blockquote></blockquote><blockquote><p><b>addItem</b></p><p><b>RTPBC isAlternative Extension</b>: true</p><p><b>RTPBC relatedCoverage Extension</b>: <a href=\"Coverage-rtpbc-coverage-non-phi-01.html\">Coverage: status = active; subscriberId = ; relationship = Self</a></p><p><b>itemSequence</b>: 1</p><p><b>productOrService</b>: <span title=\"Codes:{http://www.nlm.nih.gov/research/umls/rxnorm 205535}\">fluoxetine 10 MG Oral Capsule [Prozac]</span></p><p><b>quantity</b>: 60 {Each}</p><blockquote><p><b>adjudication</b></p><p><b>category</b>: <span title=\"Codes:{http://hl7.org/fhir/us/carin-rtpbc/CodeSystem/rtpbc-patient-pay-type-temporary cash-price}\">Full product cash price</span></p><h3>Amounts</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style=\"display: none\">*</td><td>50</td><td>United States dollar</td></tr></table></blockquote><blockquote><p><b>adjudication</b></p><p><b>category</b>: <span title=\"Codes:{http://hl7.org/fhir/us/carin-rtpbc/CodeSystem/rtpbc-patient-pay-type-temporary coupon-discount}\">Coupon discount amount</span></p><h3>Amounts</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style=\"display: none\">*</td><td>-10</td><td>United States dollar</td></tr></table></blockquote><blockquote><p><b>adjudication</b></p><p><b>category</b>: <span title=\"Codes:{http://hl7.org/fhir/us/carin-rtpbc/CodeSystem/rtpbc-patient-pay-type-temporary total}\">Total patient responsibility</span></p><h3>Amounts</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style=\"display: none\">*</td><td>40</td><td>United States dollar</td></tr></table></blockquote></blockquote></div>"
},
"identifier": [
{
"value": "rtpbc-03-response-discount-card"
}
],
"status": "active",
"type": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/claim-type",
"code": "pharmacy",
"display": "Pharmacy"
}
]
},
"use": "predetermination",
"patient": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/data-absent-reason",
"valueCode": "masked"
}
]
},
"created": "2025-11-15T13:10:13-05:00",
"insurer": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/data-absent-reason",
"valueCode": "masked"
}
]
},
"request": {
"identifier": {
"value": "rtpbc-01"
}
},
"outcome": "complete",
"disposition": "Processed successfully",
"item": [
{
"extension": [
{
"url": "http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-relatedCoverage",
"valueReference": {
"reference": "Coverage/rtpbc-coverage-non-phi-01"
}
}
],
"itemSequence": 1,
"noteNumber": [
1
],
"adjudication": [
{
"category": {
"coding": [
{
"system": "http://hl7.org/fhir/us/carin-rtpbc/CodeSystem/rtpbc-patient-pay-type-temporary",
"code": "cash-price",
"display": "Full product cash price"
}
]
},
"amount": {
"value": 105,
"currency": "USD"
}
},
{
"category": {
"coding": [
{
"system": "http://hl7.org/fhir/us/carin-rtpbc/CodeSystem/rtpbc-patient-pay-type-temporary",
"code": "coupon-discount",
"display": "Coupon discount amount"
}
]
},
"amount": {
"value": -20,
"currency": "USD"
}
},
{
"category": {
"coding": [
{
"system": "http://hl7.org/fhir/us/carin-rtpbc/CodeSystem/rtpbc-patient-pay-type-temporary",
"code": "total",
"display": "Total patient responsibility"
}
]
},
"amount": {
"value": 85,
"currency": "USD"
}
}
]
}
],
"addItem": [
{
"extension": [
{
"url": "http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-isAlternative",
"valueBoolean": true
},
{
"url": "http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-relatedCoverage",
"valueReference": {
"reference": "Coverage/rtpbc-coverage-non-phi-01"
}
}
],
"itemSequence": [
1
],
"productOrService": {
"coding": [
{
"system": "http://www.nlm.nih.gov/research/umls/rxnorm",
"code": "205535",
"display": "fluoxetine 10 MG Oral Capsule [Prozac]"
}
]
},
"quantity": {
"value": 60,
"unit": "{Each}"
},
"adjudication": [
{
"category": {
"coding": [
{
"system": "http://hl7.org/fhir/us/carin-rtpbc/CodeSystem/rtpbc-patient-pay-type-temporary",
"code": "cash-price",
"display": "Full product cash price"
}
]
},
"amount": {
"value": 50,
"currency": "USD"
}
},
{
"category": {
"coding": [
{
"system": "http://hl7.org/fhir/us/carin-rtpbc/CodeSystem/rtpbc-patient-pay-type-temporary",
"code": "coupon-discount",
"display": "Coupon discount amount"
}
]
},
"amount": {
"value": -10,
"currency": "USD"
}
},
{
"category": {
"coding": [
{
"system": "http://hl7.org/fhir/us/carin-rtpbc/CodeSystem/rtpbc-patient-pay-type-temporary",
"code": "total",
"display": "Total patient responsibility"
}
]
},
"amount": {
"value": 40,
"currency": "USD"
}
}
]
}
]
}
},
{
"fullUrl": "http://example.org/my-app/Coverage/rtpbc-coverage-non-phi-01",
"resource": {
"resourceType": "Coverage",
"id": "rtpbc-coverage-non-phi-01",
"meta": {
"profile": [
"http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-coverage-non-phi"
]
},
"text": {
"status": "extensions",
"div": "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"Coverage_rtpbc-coverage-non-phi-01\"> </a><p class=\"res-header-id\"><b>Generated Narrative: Coverage rtpbc-coverage-non-phi-01</b></p><a name=\"rtpbc-coverage-non-phi-01\"> </a><a name=\"hcrtpbc-coverage-non-phi-01\"> </a><div style=\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\"><p style=\"margin-bottom: 0px\"/><p style=\"margin-bottom: 0px\">Profile: <a href=\"StructureDefinition-rtpbc-coverage-non-phi.html\">RTPBC Coverage - Non-PHI</a></p></div><p><b>status</b>: Active</p><p><b>subscriberId</b>: Absent because : masked</p><p><b>beneficiary</b>: ?rref?</p><p><b>relationship</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/subscriber-relationship self}\">Self</span></p><p><b>payor</b>: Identifier: Med Discounts</p><blockquote><p><b>class</b></p><p><b>type</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/coverage-class rxbin}\">RX BIN</span></p><p><b>value</b>: BIN001</p></blockquote><blockquote><p><b>class</b></p><p><b>type</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/coverage-class rxpcn}\">RX PCN</span></p><p><b>value</b>: PCN002</p></blockquote><blockquote><p><b>class</b></p><p><b>type</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/coverage-class rxgroup}\">RX Group</span></p><p><b>value</b>: GROUP0001</p></blockquote><blockquote><p><b>class</b></p><p><b>type</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/coverage-class rxid}\">RX Id</span></p><p><b>value</b>: MEMBER000001</p></blockquote></div>"
},
"status": "active",
"_subscriberId": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/data-absent-reason",
"valueCode": "masked"
}
]
},
"beneficiary": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/data-absent-reason",
"valueCode": "masked"
}
]
},
"relationship": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/subscriber-relationship",
"code": "self"
}
]
},
"payor": [
{
"identifier": {
"value": "Med Discounts"
}
}
],
"class": [
{
"type": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/coverage-class",
"code": "rxbin"
}
]
},
"value": "BIN001"
},
{
"type": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/coverage-class",
"code": "rxpcn"
}
]
},
"value": "PCN002"
},
{
"type": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/coverage-class",
"code": "rxgroup"
}
]
},
"value": "GROUP0001"
},
{
"type": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/coverage-class",
"code": "rxid"
}
]
},
"value": "MEMBER000001"
}
]
}
}
]
}