haau3 FHIR Implementation Guide (HFIG)
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haau3 FHIR Implementation Guide (HFIG) - Local Development build (v1.0.0) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions

: Pharmacy Benefits answer for a member: no responder for the coverage - TTL Representation

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@prefix fhir: <http://hl7.org/fhir/> .
@prefix owl: <http://www.w3.org/2002/07/owl#> .
@prefix rdfs: <http://www.w3.org/2000/01/rdf-schema#> .
@prefix xsd: <http://www.w3.org/2001/XMLSchema#> .

# - resource -------------------------------------------------------------------

<http://hl7.org/fhir/Bundle/pharmacy-benefits-response-phi> a fhir:Bundle ;
  fhir:nodeRole fhir:treeRoot ;
  fhir:Resource.id [ fhir:value "pharmacy-benefits-response-phi"] ;
  fhir:Resource.meta [
     fhir:Meta.profile [
       fhir:value "http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-response-bundle|2.0.0-ballot" ;
       fhir:index 0 ;
       fhir:link <http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-response-bundle|2.0.0-ballot>
     ]
  ] ;
  fhir:Bundle.type [ fhir:value "message"] ;
  fhir:Bundle.timestamp [ fhir:value "2026-10-20T14:00:01Z"^^xsd:dateTime] ;
  fhir:Bundle.entry [
     fhir:index 0 ;
     fhir:Bundle.entry.fullUrl [ fhir:value "urn:uuid:10e5197b-4ed1-4379-a54e-a7a5cfd45bf4" ] ;
     fhir:Bundle.entry.resource <urn:uuid:10e5197b-4ed1-4379-a54e-a7a5cfd45bf4>
  ], [
     fhir:index 1 ;
     fhir:Bundle.entry.fullUrl [ fhir:value "urn:uuid:ad0656b7-df53-4cdb-9934-0c48f5ea9994" ] ;
     fhir:Bundle.entry.resource <urn:uuid:ad0656b7-df53-4cdb-9934-0c48f5ea9994>
  ], [
     fhir:index 2 ;
     fhir:Bundle.entry.fullUrl [ fhir:value "https://app.example.test/fhir/Patient/phi-patient" ] ;
     fhir:Bundle.entry.resource <https://app.example.test/fhir/Patient/phi-patient>
  ] .

<urn:uuid:10e5197b-4ed1-4379-a54e-a7a5cfd45bf4> a fhir:MessageHeader ;
  fhir:Resource.id [ fhir:value "10e5197b-4ed1-4379-a54e-a7a5cfd45bf4"] ;
  fhir:Resource.meta [
     fhir:Meta.profile [
       fhir:value "http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-response-messageheader|2.0.0-ballot" ;
       fhir:index 0 ;
       fhir:link <http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-response-messageheader|2.0.0-ballot>
     ]
  ] ;
  fhir:DomainResource.text [
     fhir:Narrative.status [ fhir:value "generated" ] ;
     fhir:Narrative.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>"
  ] ;
  fhir:MessageHeader.eventCoding [
     fhir:Coding.system [ fhir:value "http://hl7.org/fhir/us/carin-rtpbc/CodeSystem/rtpbc-event-type" ] ;
     fhir:Coding.code [ fhir:value "rtpbc-response" ] ;
     fhir:Coding.display [ fhir:value "RTPBC Response" ]
  ] ;
  fhir:MessageHeader.source [
     fhir:MessageHeader.source.name [ fhir:value "haau3 Pharmacy Benefits" ] ;
     fhir:MessageHeader.source.endpoint [ fhir:value "https://api.haau3.com/v1/fhir/r4" ]
  ] ;
  fhir:MessageHeader.response [
     fhir:MessageHeader.response.identifier [ fhir:value "phi-request" ] ;
     fhir:MessageHeader.response.code [ fhir:value "ok" ]
  ] ;
  fhir:MessageHeader.focus [
     fhir:index 0 ;
     fhir:Reference.reference [ fhir:value "urn:uuid:ad0656b7-df53-4cdb-9934-0c48f5ea9994" ]
  ] ;
  fhir:MessageHeader.definition [
     fhir:value "http://hl7.org/fhir/us/carin-rtpbc/MessageDefinition/rtpbc-response" ;
     fhir:link <http://hl7.org/fhir/us/carin-rtpbc/MessageDefinition/rtpbc-response>
  ] .

<urn:uuid:ad0656b7-df53-4cdb-9934-0c48f5ea9994> a fhir:ClaimResponse ;
  fhir:Resource.id [ fhir:value "ad0656b7-df53-4cdb-9934-0c48f5ea9994"] ;
  fhir:Resource.meta [
     fhir:Meta.profile [
       fhir:value "http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-response-claimresponse|2.0.0-ballot" ;
       fhir:index 0 ;
       fhir:link <http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-response-claimresponse|2.0.0-ballot>
     ]
  ] ;
  fhir:DomainResource.text [
     fhir:Narrative.status [ fhir:value "generated" ] ;
     fhir:Narrative.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>"
  ] ;
  fhir:ClaimResponse.identifier [
     fhir:index 0 ;
     fhir:Identifier.value [ fhir:value "ad0656b7-df53-4cdb-9934-0c48f5ea9994" ]
  ] ;
  fhir:ClaimResponse.status [ fhir:value "active"] ;
  fhir:ClaimResponse.type [
     fhir:CodeableConcept.coding [
       fhir:index 0 ;
       fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/claim-type" ] ;
       fhir:Coding.code [ fhir:value "pharmacy" ] ;
       fhir:Coding.display [ fhir:value "Pharmacy" ]
     ]
  ] ;
  fhir:ClaimResponse.use [ fhir:value "predetermination"] ;
  fhir:ClaimResponse.patient [
     fhir:link <https://app.example.test/fhir/Patient/phi-patient> ;
     fhir:Reference.reference [ fhir:value "https://app.example.test/fhir/Patient/phi-patient" ]
  ] ;
  fhir:ClaimResponse.created [ fhir:value "2026-10-20T14:00:01Z"^^xsd:dateTime] ;
  fhir:ClaimResponse.insurer [
     fhir:Reference.identifier [
       fhir:Identifier.system [ fhir:value "https://payers.example.test" ] ;
       fhir:Identifier.value [ fhir:value "EXAMPLE-PAYER" ]
     ]
  ] ;
  fhir:ClaimResponse.request [
     fhir:Reference.identifier [
       fhir:Identifier.value [ fhir:value "benefit-check-0001" ]
     ]
  ] ;
  fhir:ClaimResponse.outcome [ fhir:value "error"] ;
  fhir:ClaimResponse.disposition [ fhir:value "No insurer this service connects to answers for this coverage's payer."] ;
  fhir:ClaimResponse.error [
     fhir:index 0 ;
     fhir:ClaimResponse.error.code [
       fhir:CodeableConcept.coding [
         fhir:index 0 ;
         fhir:Coding.system [ fhir:value "https://haau3.com/fhir/CodeSystem/pharmacy-benefits-processing-code" ] ;
         fhir:Coding.code [ fhir:value "no-responder-for-coverage" ] ;
         fhir:Coding.display [ fhir:value "No responder for this coverage" ]
       ]
     ]
  ] .

<https://app.example.test/fhir/Patient/phi-patient> a fhir:Patient ;
  fhir:Resource.id [ fhir:value "phi-patient"] ;
  fhir:Resource.meta [
     fhir:Meta.profile [
       fhir:value "http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-patient|2.0.0-ballot" ;
       fhir:index 0 ;
       fhir:link <http://hl7.org/fhir/us/carin-rtpbc/StructureDefinition/rtpbc-patient|2.0.0-ballot>
     ]
  ] ;
  fhir:DomainResource.text [
     fhir:Narrative.status [ fhir:value "generated" ] ;
     fhir:Narrative.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>"
  ] ;
  fhir:Patient.identifier [
     fhir:index 0 ;
     fhir:Identifier.system [ fhir:value "https://app.example.test/patients" ] ;
     fhir:Identifier.value [ fhir:value "example-0001" ]
  ] ;
  fhir:Patient.name [
     fhir:index 0 ;
     fhir:HumanName.family [ fhir:value "Lin" ] ;
     fhir:HumanName.given [
       fhir:value "Mei" ;
       fhir:index 0
     ]
  ] ;
  fhir:Patient.gender [ fhir:value "female"] ;
  fhir:Patient.birthDate [ fhir:value "1958-03-14"^^xsd:date] .

# - ontology header ------------------------------------------------------------

<http://hl7.org/fhir/Bundle/pharmacy-benefits-response-phi.ttl> a owl:Ontology ;
  owl:imports fhir:fhir.ttl ;
  owl:versionIRI <http://build.fhir.org/Bundle/pharmacy-benefits-response-phi.ttl> .