Message Examples

rtpbrequest example \<?xml version="1 0" encoding="utf 8"?> \<message rtpbdatatypesversion="pbv13" rtpbtransportversion="pbv13" rtpbtransactiondomain="rtpb" rtpbtransactionversion="pbv13" rtpbstructuresversion="pbv13" rtpbeclversion="pbv13" rtpbversion="pbv13"> \<rtpbheader> \<to> \<primary> \<identification>017010\</identification> \<qualifier>iin\</qualifier> \</primary> \<secondary> \<identification>0215comm\</identification> \<qualifier>pcn\</qualifier> \</secondary> \<tertiary> \<identification>123456789\</identification> \<qualifier>py\</qualifier> \</tertiary> \</to> \<from> \<primary> \<identification>123456789\</identification \<qualifier>p\</qualifier> \</primary> \</from> \<messageid>316c5d95571c4f35acdb9fb5324181e7\</messageid> \<relatestomessageid>newrxmessageid\</relatestomessageid> \<senttime>2025 02 20t10 10 03 9247997z\</senttime> \<softwaresendercertificationid>123456789\</softwaresendercertificationid> \</rtpbheader> \<rtpbbody> \<rtpbrequest> \<patient> \<name> \<lastname>king\</lastname> \<firstname>abe\</firstname> \</name> \<sexandgender> \<administrativegender>m\</administrativegender> \</sexandgender> \<dateofbirth>1955 06 12\</dateofbirth> \<stateprovince>az\</stateprovince> \<postalcode>97884\</postalcode> \<countrycode>us\</countrycode> \<extension name="city" url="http //surescripts com/extensions/rtpbrequest/patient/city"> \<string>warren\</string> \</extension> \</patient> \<benefitscoordination> \<groupid>1234\</groupid> \</benefitscoordination> \<requestedproduct> \<product> \<drugcoded> \<ndc>00456401001\</ndc> \</drugcoded> \</product> \<quantity> \<value>30\</value> \<codelistqualifier>38\</codelistqualifier> \<quantityunitofmeasure> \<code>c28254\</code> \</quantityunitofmeasure> \</quantity> \<dayssupply>30\</dayssupply> \</requestedproduct> \<prescriber> \<identification> \<npi>1234567890\</npi> \</identification> \<lastname>unknown\</lastname> \</prescriber> \<pharmacy> \<identification> \<ncpdpid>9999999\</ncpdpid> \<npi>1234567890\</npi> \</identification> \<businessname>pharmacybusinessname\</businessname> \<primarytelephonenumber>5556667777\</primarytelephonenumber> \</pharmacy> \</rtpbrequest> \</rtpbbody> \</message> rtpbresponse example \<?xml version="1 0" encoding="utf 8"?> \<message rtpbdatatypesversion="pbv13" rtpbtransportversion="pbv13" rtpbtransactiondomain="rtpb" rtpbtransactionversion="pbv13" rtpbstructuresversion="pbv13" rtpbeclversion="pbv13" rtpbversion="pbv13"> \<rtpbheader> \<to> \<primary> \<identification>d00000000123597\</identification> \<qualifier>p\</qualifier> \</primary> \</to> \<from> \<primary> \<identification>434257\</identification> \<qualifier>iin\</qualifier> \</primary> \<secondary> \<identification>012345\</identification> \<qualifier>pcn\</qualifier> \</secondary> \<tertiary> \<identification>d00000000478396\</identification> \<qualifier>py\</qualifier> \</tertiary> \</from> \<messageid>somegeneratedid\</messageid> \<relatestomessageid>requestidsentfromehr\</relatestomessageid> \<senttime>2025 03 12t10 10 02 9587124z\</senttime> \</rtpbheader> \<rtpbbody> \<rtpbresponse> \<response> \<processed> \<note>success\</note> \</processed> \</response> \<extension name=" benefitscoordination " url="http //surescripts com/extensions/ benefitscoordination"> \<extension name="payername" url="payername"> \<string>123456789\</string> \</extension> \<extension name="processorindentificationnumber" url="processorindentificationnumber"> \<string>123456789\</string> \</extension> \<extension name="iinnumber" url="iinnumber"> \<string>123456789\</string> \</extension> \<extension name="cardholderid" url="cardholderid"> \<string>123456789\</string> \</extension> \<extension name="groupid" url="groupid"> \<string>123456789\</string> \</extension> \<extension name="groupname" url="groupname"> \<string>123456789\</string> \</extension> \<extension name="pbmmemberid" url="pbmmemberid"> \<string>123456789\</string> \</extension> \</extension> \<responseproduct> \<product> \<drugcoded> \<ndc>00456401001\</ndc> \</drugcoded> \</product> \<drugdescription>celexa 10mg tablet\</drugdescription> \<quantity> \<value>30\</value> \<codelistqualifier>38\</codelistqualifier> \<quantityunitofmeasure> \<code>c28254\</code> \</quantityunitofmeasure> \</quantity> \<pricingandcoverages> \<pharmacy> \<pharmacytype>r\</pharmacytype> \<identification> \<ncpdpid>9999999\</ncpdpid> \<npi>1234567890\</npi> \</identification> \<businessname>pharmacybusinessname\</businessname> \</pharmacy> \<pricingandcoverage> \<pricingandcoverageindicator>r\</pricingandcoverageindicator> \<coveragestatuscode>cc\</coveragestatuscode> \<formularystatus>u\</formularystatus> \<quantity> \<value>30\</value> \<codelistqualifier>38\</codelistqualifier> \<quantityunitofmeasure> \<code>c28254\</code> \</quantityunitofmeasure> \</quantity> \<dayssupply>30\</dayssupply> \<estimatedpatientfinancialresponsibility>703 39\</estimatedpatientfinancialresponsibility> \<patientpaycomponent> \<patientpaycomponentqualifier>01\</patientpaycomponentqualifier> \<patientpaycomponentamount>0 3\</patientpaycomponentamount> \</patientpaycomponent> \<remainingdeductibleamount>40\</remainingdeductibleamount> \<estimatednetplancost>3176 67\</estimatednetplancost> \</pricingandcoverage> \</pricingandcoverages> \<pricingandcoverages> \<pharmacy> \<pharmacytype>r\</pharmacytype> \<identification> \<ncpdpid>9999999\</ncpdpid> \<npi>1234567890\</npi> \</identification> \<businessname>pharmacybusinessname\</businessname> \</pharmacy> \<pricingandcoverage> \<pricingandcoverageindicator>d\</pricingandcoverageindicator> \<coveragestatuscode>cr\</coveragestatuscode> \<formularystatus>u\</formularystatus> \<quantity> \<value>90\</value> \<codelistqualifier>38\</codelistqualifier> \<quantityunitofmeasure> \<code>c28254\</code> \</quantityunitofmeasure> \</quantity> \<dayssupply>90\</dayssupply> \<coveragerestriction> \<coveragerestrictioncode>7x\</coveragerestrictioncode> \</coveragerestriction> \</pricingandcoverage> \</pricingandcoverages> \</responseproduct> \<responsealternativeproduct> \<product> \<drugcoded> \<ndc>00185037101\</ndc> \</drugcoded> \</product> \<drugdescription>firstalternate\</drugdescription> \<pricingandcoverages> \<pharmacy> \<pharmacytype>r\</pharmacytype> \<identification> \<ncpdpid>9999999\</ncpdpid> \<npi>1234567890\</npi> \</identification> \<businessname>pharmacybusinessname\</businessname> \</pharmacy> \<pricingandcoverage> \<pricingandcoverageindicator>r\</pricingandcoverageindicator> \<coveragestatuscode>cc\</coveragestatuscode> \<formularystatus>u\</formularystatus> \<quantity> \<value>30\</value> \<codelistqualifier>38\</codelistqualifier> \<quantityunitofmeasure> \<code>c28254\</code> \</quantityunitofmeasure> \</quantity> \<dayssupply>30\</dayssupply> \<estimatedpatientfinancialresponsibility>3 6\</estimatedpatientfinancialresponsibility> \</pricingandcoverage> \</pricingandcoverages> \</responsealternativeproduct> \<responsealternativeproduct> \<product> \<drugcoded> \<ndc>00378700110\</ndc> \</drugcoded> \</product> \<drugdescription>secondalternate\</drugdescription> \<pricingandcoverages> \<pharmacy> \<pharmacytype>r\</pharmacytype> \<identification> \<ncpdpid>9999999\</ncpdpid> \<npi>1234567890\</npi> \</identification> \<businessname>pharmacybusinessname\</businessname> \</pharmacy> \<pricingandcoverage> \<pricingandcoverageindicator>r\</pricingandcoverageindicator> \<coveragestatuscode>cc\</coveragestatuscode> \<formularystatus>u\</formularystatus> \<quantity> \<value>30\</value> \<codelistqualifier>38\</codelistqualifier> \<quantityunitofmeasure> \<code>c28254\</code> \</quantityunitofmeasure> \</quantity> \<dayssupply>30\</dayssupply> \<estimatedpatientfinancialresponsibility>3 6\</estimatedpatientfinancialresponsibility> \</pricingandcoverage> \</pricingandcoverages> \</responsealternativeproduct> \</rtpbresponse> \</rtpbbody> \</message>