haau3 FHIR Implementation Guide (HFIG)
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: Pharmacy Benefits answer for a member: no responder for the coverage - JSON Representation

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{
  "resourceType" : "Bundle",
  "id" : "pharmacy-benefits-response-phi",
  "meta" : {
    "profile" : [
      "http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-response-bundle|2.0.0-ballot"
    ]
  },
  "type" : "message",
  "timestamp" : "2026-10-20T14:00:01Z",
  "entry" : [
    {
      "fullUrl" : "urn:uuid:10e5197b-4ed1-4379-a54e-a7a5cfd45bf4",
      "resource" : {
        "resourceType" : "MessageHeader",
        "id" : "10e5197b-4ed1-4379-a54e-a7a5cfd45bf4",
        "meta" : {
          "profile" : [
            "http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-response-messageheader|2.0.0-ballot"
          ]
        },
        "text" : {
          "status" : "generated",
          "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"MessageHeader_10e5197b-4ed1-4379-a54e-a7a5cfd45bf4\"> </a><p class=\"res-header-id\"><b>Generated Narrative: MessageHeader 10e5197b-4ed1-4379-a54e-a7a5cfd45bf4</b></p><a name=\"10e5197b-4ed1-4379-a54e-a7a5cfd45bf4\"> </a><a name=\"hc10e5197b-4ed1-4379-a54e-a7a5cfd45bf4\"> </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: <code>http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-response-messageheader|2.0.0-ballot</code></p></div><p><b>event</b>: rtpbc-event-type: rtpbc-response (RTPBC 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>haau3 Pharmacy Benefits</td><td><a href=\"https://api.haau3.com/v1/fhir/r4\">https://api.haau3.com/v1/fhir/r4</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>phi-request</td><td>OK</td></tr></table><p><b>focus</b>: <a href=\"Bundle-pharmacy-benefits-response-phi.html#urn-uuid-ad0656b7-df53-4cdb-9934-0c48f5ea9994\">ClaimResponse: identifier = ad0656b7-df53-4cdb-9934-0c48f5ea9994; status = active; type = Pharmacy; use = predetermination; created = 2026-10-20 14:00:01+0000; outcome = error; disposition = No insurer this service connects to answers for this coverage's payer.</a></p><p><b>definition</b>: <code>http://hl7.org/fhir/us/carin-rtpbc/MessageDefinition/rtpbc-response</code></p></div>"
        },
        "eventCoding" : {
          "system" : "http://hl7.org/fhir/us/carin-rtpbc/CodeSystem/rtpbc-event-type",
          "code" : "rtpbc-response",
          "display" : "RTPBC Response"
        },
        "source" : {
          "name" : "haau3 Pharmacy Benefits",
          "endpoint" : "https://api.haau3.com/v1/fhir/r4"
        },
        "response" : {
          "identifier" : "phi-request",
          "code" : "ok"
        },
        "focus" : [
          {
            "reference" : "urn:uuid:ad0656b7-df53-4cdb-9934-0c48f5ea9994"
          }
        ],
        "definition" : "http://hl7.org/fhir/us/carin-rtpbc/MessageDefinition/rtpbc-response"
      }
    },
    {
      "fullUrl" : "urn:uuid:ad0656b7-df53-4cdb-9934-0c48f5ea9994",
      "resource" : {
        "resourceType" : "ClaimResponse",
        "id" : "ad0656b7-df53-4cdb-9934-0c48f5ea9994",
        "meta" : {
          "profile" : [
            "http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-response-claimresponse|2.0.0-ballot"
          ]
        },
        "text" : {
          "status" : "generated",
          "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"ClaimResponse_ad0656b7-df53-4cdb-9934-0c48f5ea9994\"> </a><p class=\"res-header-id\"><b>Generated Narrative: ClaimResponse ad0656b7-df53-4cdb-9934-0c48f5ea9994</b></p><a name=\"ad0656b7-df53-4cdb-9934-0c48f5ea9994\"> </a><a name=\"hcad0656b7-df53-4cdb-9934-0c48f5ea9994\"> </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: <code>http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-response-claimresponse|2.0.0-ballot</code></p></div><p><b>identifier</b>: ad0656b7-df53-4cdb-9934-0c48f5ea9994</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>: <a href=\"Bundle-pharmacy-benefits-request-phi.html#https-//app.example.test/fhir/Patient/phi-patient\">Mei Lin  Female, DoB: 1958-03-14 ( https://app.example.test/patients#example-0001)</a></p><p><b>created</b>: 2026-10-20 14:00:01+0000</p><p><b>insurer</b>: Identifier: <code>https://payers.example.test</code>/EXAMPLE-PAYER</p><p><b>request</b>: Identifier: benefit-check-0001</p><p><b>outcome</b>: Error</p><p><b>disposition</b>: No insurer this service connects to answers for this coverage's payer.</p><h3>Errors</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Code</b></td></tr><tr><td style=\"display: none\">*</td><td><span title=\"Codes:{https://haau3.com/fhir/CodeSystem/pharmacy-benefits-processing-code no-responder-for-coverage}\">No responder for this coverage</span></td></tr></table></div>"
        },
        "identifier" : [
          {
            "value" : "ad0656b7-df53-4cdb-9934-0c48f5ea9994"
          }
        ],
        "status" : "active",
        "type" : {
          "coding" : [
            {
              "system" : "http://terminology.hl7.org/CodeSystem/claim-type",
              "code" : "pharmacy",
              "display" : "Pharmacy"
            }
          ]
        },
        "use" : "predetermination",
        "patient" : {
          "reference" : "https://app.example.test/fhir/Patient/phi-patient"
        },
        "created" : "2026-10-20T14:00:01Z",
        "insurer" : {
          "identifier" : {
            "system" : "https://payers.example.test",
            "value" : "EXAMPLE-PAYER"
          }
        },
        "request" : {
          "identifier" : {
            "value" : "benefit-check-0001"
          }
        },
        "outcome" : "error",
        "disposition" : "No insurer this service connects to answers for this coverage's payer.",
        "error" : [
          {
            "code" : {
              "coding" : [
                {
                  "system" : "https://haau3.com/fhir/CodeSystem/pharmacy-benefits-processing-code",
                  "code" : "no-responder-for-coverage",
                  "display" : "No responder for this coverage"
                }
              ]
            }
          }
        ]
      }
    },
    {
      "fullUrl" : "https://app.example.test/fhir/Patient/phi-patient",
      "resource" : {
        "resourceType" : "Patient",
        "id" : "phi-patient",
        "meta" : {
          "profile" : [
            "http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-patient|2.0.0-ballot"
          ]
        },
        "text" : {
          "status" : "generated",
          "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"Patient_phi-patient\"> </a><p class=\"res-header-id\"><b>Generated Narrative: Patient phi-patient</b></p><a name=\"phi-patient\"> </a><a name=\"hcphi-patient\"> </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: <code>http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-patient|2.0.0-ballot</code></p></div><p style=\"border: 1px #661aff solid; background-color: #e6e6ff; padding: 10px;\">Mei Lin  Female, DoB: 1958-03-14 ( https://app.example.test/patients#example-0001)</p><hr/></div>"
        },
        "identifier" : [
          {
            "system" : "https://app.example.test/patients",
            "value" : "example-0001"
          }
        ],
        "name" : [
          {
            "family" : "Lin",
            "given" : [
              "Mei"
            ]
          }
        ],
        "gender" : "female",
        "birthDate" : "1958-03-14"
      }
    }
  ]
}