XIG: CodeSystem/rtpbc-benefit-restriction

FHIR IG Statistics: CodeSystem/rtpbc-benefit-restriction

Package	hl7.fhir.us.carin-rtpbc
Resource Type	CodeSystem
Id	rtpbc-benefit-restriction
FHIR Version	R4
Source	http://hl7.org/fhir/us/carin-rtpbc/https://build.fhir.org/ig/HL7/carin-rtpbc/CodeSystem-rtpbc-benefit-restriction.html
URL	http://hl7.org/fhir/us/carin-rtpbc/CodeSystem/rtpbc-benefit-restriction
Version	2.0.0
Status	active
Date	2020-05-23T00:00:00-05:00
Name	RtpbcBenefitRestrictionCodeSystem
Title	RTPBC Benefit Restriction Code System
Realm	us
Authority	hl7
Description	This code system defines a set of benefit restrictions that may apply to a prescription product and pharmacy combination evaluated in the Real-time Pharmacy Benefit Check (RTPBC) process.
Content	complete

Resources that use this resource

ValueSet
rtpbc-benefit-restriction	RTPBC Benefit Restriction Value Set

Resources that this resource uses

No resources found

Narrative

Note: links and images are rebased to the (stated) source

Generated Narrative: CodeSystem rtpbc-benefit-restriction

This case-insensitive code system http://hl7.org/fhir/us/carin-rtpbc/CodeSystem/rtpbc-benefit-restriction defines the following codes:

Code	Display	Definition
covered	Covered	Covered
prior-auth	Prior authorization required	Covered with restriction: Prior authorization required
step-therapy	Step therapy applies	Covered with restriction: Step therapy applies
quantity-limit	Quantity limit applies	Covered with restriction: Quantity limit applies
pharmacy-restriction	Pharmacy restriction applies	Covered with restriction: Pharmacy restriction applies
other-restriction	Other restriction applies	Covered with restriction: Other restriction applies
not-covered	Not covered	Not covered

Source

{
  "resourceType": "CodeSystem",
  "id": "rtpbc-benefit-restriction",
  "text": {
    "status": "generated",
    "div": "<!-- snip (see above) -->"
  },
  "extension": [
    {
      "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-wg",
      "valueCode": "phx"
    },
    {
      "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fmm",
      "valueInteger": 4,
      "_valueInteger": {
        "extension": [
          {
            "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom",
            "valueCanonical": "http://hl7.org/fhir/us/carin-rtpbc/ImplementationGuide/hl7.fhir.us.carin-rtpbc"
          }
        ]
      }
    },
    {
      "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
      "valueCode": "trial-use",
      "_valueCode": {
        "extension": [
          {
            "url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-conformance-derivedFrom",
            "valueCanonical": "http://hl7.org/fhir/us/carin-rtpbc/ImplementationGuide/hl7.fhir.us.carin-rtpbc"
          }
        ]
      }
    }
  ],
  "url": "http://hl7.org/fhir/us/carin-rtpbc/CodeSystem/rtpbc-benefit-restriction",
  "version": "2.0.0",
  "name": "RtpbcBenefitRestrictionCodeSystem",
  "title": "RTPBC Benefit Restriction Code System",
  "status": "active",
  "experimental": false,
  "date": "2020-05-23T00:00:00-05:00",
  "publisher": "HL7 International / Pharmacy",
  "contact": [
    {
      "name": "HL7 International / Pharmacy",
      "telecom": [
        {
          "system": "url",
          "value": "http://www.hl7.org/Special/committees/medication"
        }
      ]
    },
    {
      "name": "Frank McKinney",
      "telecom": [
        {
          "system": "email",
          "value": "fm@frankmckinney.com"
        }
      ]
    }
  ],
  "description": "This code system defines a set of benefit restrictions that may apply to a prescription product and pharmacy combination evaluated in the Real-time Pharmacy Benefit Check (RTPBC) process.",
  "jurisdiction": [
    {
      "coding": [
        {
          "system": "urn:iso:std:iso:3166",
          "code": "US",
          "display": "United States of America"
        }
      ]
    }
  ],
  "caseSensitive": false,
  "content": "complete",
  "count": 7,
  "concept": [
    {
      "code": "covered",
      "display": "Covered",
      "definition": "Covered"
    },
    {
      "code": "prior-auth",
      "display": "Prior authorization required",
      "definition": "Covered with restriction: Prior authorization required"
    },
    {
      "code": "step-therapy",
      "display": "Step therapy applies",
      "definition": "Covered with restriction: Step therapy applies"
    },
    {
      "code": "quantity-limit",
      "display": "Quantity limit applies",
      "definition": "Covered with restriction: Quantity limit applies"
    },
    {
      "code": "pharmacy-restriction",
      "display": "Pharmacy restriction applies",
      "definition": "Covered with restriction: Pharmacy restriction applies"
    },
    {
      "code": "other-restriction",
      "display": "Other restriction applies",
      "definition": "Covered with restriction: Other restriction applies"
    },
    {
      "code": "not-covered",
      "display": "Not covered",
      "definition": "Not covered"
    }
  ]
}