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
<Bundle xmlns="http://hl7.org/fhir">
<id value="bundle-chargeback-adjudicated"/>
<type value="message"/>
<timestamp value="2026-04-24T15:02:00Z"/>
<entry>
<fullUrl value="urn:uuid:77777777-7777-4777-8777-777777777777"/>
<resource>
<MessageHeader>
<text>
<status value="generated"/>
<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>
</text>
<eventCoding>
<system value="https://exchange.example.org/events"/>
<code value="340b.chargeback.adjudicated"/>
</eventCoding>
<source>
<endpoint value="urn:system:manufacturer-77"/>
</source>
<focus>
<reference value="urn:uuid:88888888-8888-4888-8888-888888888888"/>
</focus>
</MessageHeader>
</resource>
</entry>
<entry>
<fullUrl value="urn:uuid:88888888-8888-4888-8888-888888888888"/>
<resource>
<ClaimResponse>
<id value="cr-340b-1001"/>
<text>
<status value="extensions"/>
<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>
</text>
<extension
url="https://exchange.example.org/fhir/ig/340b-exchange/StructureDefinition/340b-exchange-transaction-id">
<valueString value="tx-1002"/>
</extension>
<extension
url="https://exchange.example.org/fhir/ig/340b-exchange/StructureDefinition/340b-correlation-id">
<valueString value="corr-9001"/>
</extension>
<status value="active"/>
<type>
<coding>
<system value="http://terminology.hl7.org/CodeSystem/claim-type"/>
<code value="pharmacy"/>
</coding>
</type>
<use value="claim"/>
<patient>
<reference value="urn:uuid:33333333-3333-4333-8333-333333333333"/>
</patient>
<created value="2026-04-24"/>
<insurer>
<reference value="urn:uuid:55555555-5555-4555-8555-555555555555"/>
</insurer>
<request>
<reference value="https://example.org/fhir/Claim/claim-340b-1001"/>
</request>
<outcome value="complete"/>
<disposition value="Approved"/>
<item>
<itemSequence value="1"/>
<adjudication>
<category>
<text value="allowed"/>
</category>
<amount>
<value value="125.42"/>
<currency value="USD"/>
</amount>
</adjudication>
</item>
</ClaimResponse>
</resource>
</entry>
<entry>
<fullUrl value="urn:uuid:33333333-3333-4333-8333-333333333333"/>
<resource>
<Patient>
<id value="p-001"/>
<text>
<status value="generated"/>
<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>
</text>
<name>
<family value="Example"/>
<given value="Pat"/>
</name>
</Patient>
</resource>
</entry>
<entry>
<fullUrl value="urn:uuid:55555555-5555-4555-8555-555555555555"/>
<resource>
<Organization>
<id value="manufacturer-77"/>
<text>
<status value="generated"/>
<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>
</text>
<name value="Example Manufacturer 77"/>
</Organization>
</resource>
</entry>
</Bundle>