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-submitted",
"meta" : {
"profile" : [
🔗 "https://exchange.example.org/fhir/ig/340b-exchange/StructureDefinition/340b-message-bundle"
]
},
"identifier" : {
"system" : "https://exchange.example.org/bundle-ids",
"value" : "bundle-sub-1001"
},
"type" : "message",
"timestamp" : "2026-04-24T15:00:00Z",
"entry" : [
{
"fullUrl" : "urn:uuid:11111111-1111-4111-8111-111111111111",
"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.submitted (340b.chargeback.submitted)</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:tpa-01</td></tr></table><p><b>focus</b>: <a href=\"Bundle-bundle-chargeback-submitted.html#urn-uuid-22222222-2222-4222-8222-222222222222\">Claim: extension = tx-1001,corr-9001,1.2.0,https://exchange.example.org/chargeback#cb-1001; status = active; type = Pharmacy; use = claim; created = 2026-04-24; priority = Normal</a></p></div>"
},
"eventCoding" : {
"system" : "https://exchange.example.org/events",
"code" : "340b.chargeback.submitted"
},
"source" : {
"endpoint" : "urn:system:tpa-01"
},
"focus" : [
{
"reference" : "urn:uuid:22222222-2222-4222-8222-222222222222"
}
]
}
},
{
"fullUrl" : "urn:uuid:22222222-2222-4222-8222-222222222222",
"resource" : {
"resourceType" : "Claim",
"id" : "claim-340b-1001",
"text" : {
"status" : "extensions",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"Claim_claim-340b-1001\"> </a><p class=\"res-header-id\"><b>Generated Narrative: Claim claim-340b-1001</b></p><a name=\"claim-340b-1001\"> </a><a name=\"hcclaim-340b-1001\"> </a><p><b>340B Exchange Transaction ID Extension</b>: tx-1001</p><p><b>340B Correlation ID Extension</b>: corr-9001</p><p><b>340B Rule Set Version Extension</b>: 1.2.0</p><p><b>340B Chargeback Reference Extension</b>: <code>https://exchange.example.org/chargeback</code>/cb-1001</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>provider</b>: <a href=\"Bundle-bundle-chargeback-submitted.html#urn-uuid-44444444-4444-4444-8444-444444444444\">Organization Example Pharmacy 22</a></p><p><b>priority</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/processpriority normal}\">Normal</span></p><h3>Insurances</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Sequence</b></td><td><b>Focal</b></td><td><b>Coverage</b></td></tr><tr><td style=\"display: none\">*</td><td>1</td><td>true</td><td><a href=\"Bundle-bundle-chargeback-submitted.html#urn-uuid-66666666-6666-4666-8666-666666666666\">Coverage: status = active</a></td></tr></table><h3>Items</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Sequence</b></td><td><b>ProductOrService</b></td></tr><tr><td style=\"display: none\">*</td><td>1</td><td><span title=\"Codes:{http://example.org/drug-codes 00000-1111-22}\">00000-1111-22</span></td></tr></table></div>"
},
"extension" : [
{
"url" : "https://exchange.example.org/fhir/ig/340b-exchange/StructureDefinition/340b-exchange-transaction-id",
"valueString" : "tx-1001"
},
{
"url" : "https://exchange.example.org/fhir/ig/340b-exchange/StructureDefinition/340b-correlation-id",
"valueString" : "corr-9001"
},
{
"url" : "https://exchange.example.org/fhir/ig/340b-exchange/StructureDefinition/340b-rule-set-version",
"valueString" : "1.2.0"
},
{
"url" : "https://exchange.example.org/fhir/ig/340b-exchange/StructureDefinition/340b-chargeback-reference",
"valueIdentifier" : {
"system" : "https://exchange.example.org/chargeback",
"value" : "cb-1001"
}
}
],
"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"
},
"provider" : {
"reference" : "urn:uuid:44444444-4444-4444-8444-444444444444"
},
"priority" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/processpriority",
"code" : "normal"
}
]
},
"insurance" : [
{
"sequence" : 1,
"focal" : true,
"coverage" : {
"reference" : "urn:uuid:66666666-6666-4666-8666-666666666666"
}
}
],
"item" : [
{
"sequence" : 1,
"productOrService" : {
"coding" : [
{
"system" : "http://example.org/drug-codes",
"code" : "00000-1111-22"
}
]
}
}
]
}
},
{
"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:44444444-4444-4444-8444-444444444444",
"resource" : {
"resourceType" : "Organization",
"id" : "pharmacy-22",
"text" : {
"status" : "generated",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"Organization_pharmacy-22\"> </a><p class=\"res-header-id\"><b>Generated Narrative: Organization pharmacy-22</b></p><a name=\"pharmacy-22\"> </a><a name=\"hcpharmacy-22\"> </a><p><b>name</b>: Example Pharmacy 22</p></div>"
},
"name" : "Example Pharmacy 22"
}
},
{
"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"
}
},
{
"fullUrl" : "urn:uuid:66666666-6666-4666-8666-666666666666",
"resource" : {
"resourceType" : "Coverage",
"id" : "cov-001",
"text" : {
"status" : "generated",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"Coverage_cov-001\"> </a><p class=\"res-header-id\"><b>Generated Narrative: Coverage cov-001</b></p><a name=\"cov-001\"> </a><a name=\"hccov-001\"> </a><p><b>status</b>: Active</p><p><b>beneficiary</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>payor</b>: <a href=\"Bundle-bundle-chargeback-adjudicated.html#urn-uuid-55555555-5555-4555-8555-555555555555\">Organization Example Manufacturer 77</a></p></div>"
},
"status" : "active",
"beneficiary" : {
"reference" : "urn:uuid:33333333-3333-4333-8333-333333333333"
},
"payor" : [
{
"reference" : "urn:uuid:55555555-5555-4555-8555-555555555555"
}
]
}
}
]
}