340B FHIR Exchange Implementation Guide
0.1.0-ballot - ci-build
340B FHIR Exchange Implementation Guide
0.1.0-ballot - ci-build
340B FHIR Exchange Implementation Guide - Local Development build (v0.1.0-ballot) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions
{
"resourceType" : "Bundle",
"id" : "bundle-chargeback-adjudicated",
"type" : "message",
"timestamp" : "2026-04-24T15:02:00Z",
"entry" : [
{
"fullUrl" : "urn:uuid:77777777-7777-4777-8777-777777777777",
"resource" : {
"resourceType" : "MessageHeader",
"text" : {
"status" : "generated",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"MessageHeader_null\"> </a><p class=\"res-header-id\"><b>Generated Narrative: MessageHeader </b></p><p><b>event</b>: events: 340b.chargeback.adjudicated (340b.chargeback.adjudicated)</p><h3>Sources</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Endpoint</b></td></tr><tr><td style=\"display: none\">*</td><td>urn:system:manufacturer-77</td></tr></table><p><b>focus</b>: <a href=\"Bundle-bundle-chargeback-adjudicated.html#urn-uuid-88888888-8888-4888-8888-888888888888\">ClaimResponse: extension = tx-1002,corr-9001; status = active; type = Pharmacy; use = claim; created = 2026-04-24; outcome = complete; disposition = Approved</a></p></div>"
},
"eventCoding" : {
"system" : "https://exchange.example.org/events",
"code" : "340b.chargeback.adjudicated"
},
"source" : {
"endpoint" : "urn:system:manufacturer-77"
},
"focus" : [
{
"reference" : "urn:uuid:88888888-8888-4888-8888-888888888888"
}
]
}
},
{
"fullUrl" : "urn:uuid:88888888-8888-4888-8888-888888888888",
"resource" : {
"resourceType" : "ClaimResponse",
"id" : "cr-340b-1001",
"text" : {
"status" : "extensions",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"ClaimResponse_cr-340b-1001\"> </a><p class=\"res-header-id\"><b>Generated Narrative: ClaimResponse cr-340b-1001</b></p><a name=\"cr-340b-1001\"> </a><a name=\"hccr-340b-1001\"> </a><p><b>340B Exchange Transaction ID Extension</b>: tx-1002</p><p><b>340B Correlation ID Extension</b>: corr-9001</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>: Claim</p><p><b>patient</b>: <a href=\"Bundle-bundle-chargeback-adjudicated.html#urn-uuid-33333333-3333-4333-8333-333333333333\">Pat Example (no stated gender), DoB Unknown</a></p><p><b>created</b>: 2026-04-24</p><p><b>insurer</b>: <a href=\"Bundle-bundle-chargeback-adjudicated.html#urn-uuid-55555555-5555-4555-8555-555555555555\">Organization Example Manufacturer 77</a></p><p><b>request</b>: <a href=\"https://example.org/fhir/Claim/claim-340b-1001\">https://example.org/fhir/Claim/claim-340b-1001</a></p><p><b>outcome</b>: Processing Complete</p><p><b>disposition</b>: Approved</p><blockquote><p><b>item</b></p><p><b>itemSequence</b>: 1</p><blockquote><p><b>adjudication</b></p><p><b>category</b>: <span title=\"Codes:\">allowed</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>125.42</td><td>United States dollar</td></tr></table></blockquote></blockquote></div>"
},
"extension" : [
{
"url" : "https://exchange.example.org/fhir/ig/340b-exchange/StructureDefinition/340b-exchange-transaction-id",
"valueString" : "tx-1002"
},
{
"url" : "https://exchange.example.org/fhir/ig/340b-exchange/StructureDefinition/340b-correlation-id",
"valueString" : "corr-9001"
}
],
"status" : "active",
"type" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/claim-type",
"code" : "pharmacy"
}
]
},
"use" : "claim",
"patient" : {
"reference" : "urn:uuid:33333333-3333-4333-8333-333333333333"
},
"created" : "2026-04-24",
"insurer" : {
"reference" : "urn:uuid:55555555-5555-4555-8555-555555555555"
},
"request" : {
"reference" : "https://example.org/fhir/Claim/claim-340b-1001"
},
"outcome" : "complete",
"disposition" : "Approved",
"item" : [
{
"itemSequence" : 1,
"adjudication" : [
{
"category" : {
"text" : "allowed"
},
"amount" : {
"value" : 125.42,
"currency" : "USD"
}
}
]
}
]
}
},
{
"fullUrl" : "urn:uuid:33333333-3333-4333-8333-333333333333",
"resource" : {
"resourceType" : "Patient",
"id" : "p-001",
"text" : {
"status" : "generated",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"Patient_p-001\"> </a><p class=\"res-header-id\"><b>Generated Narrative: Patient p-001</b></p><a name=\"p-001\"> </a><a name=\"hcp-001\"> </a><p style=\"border: 1px #661aff solid; background-color: #e6e6ff; padding: 10px;\">Pat Example (no stated gender), DoB Unknown</p><hr/></div>"
},
"name" : [
{
"family" : "Example",
"given" : [
"Pat"
]
}
]
}
},
{
"fullUrl" : "urn:uuid:55555555-5555-4555-8555-555555555555",
"resource" : {
"resourceType" : "Organization",
"id" : "manufacturer-77",
"text" : {
"status" : "generated",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"Organization_manufacturer-77\"> </a><p class=\"res-header-id\"><b>Generated Narrative: Organization manufacturer-77</b></p><a name=\"manufacturer-77\"> </a><a name=\"hcmanufacturer-77\"> </a><p><b>name</b>: Example Manufacturer 77</p></div>"
},
"name" : "Example Manufacturer 77"
}
}
]
}