Review the CARIN BB Pharmacy EOB profile to understand required elements specific to pharmacy claims, including NDC codes on EOB.item.productOrService and days supply on EOB.supportingInfo.
Set EOB.type to the pharmacy claim type code defined in the CARIN BB value set and populate EOB.item with the NDC (National Drug Code) for the dispensed drug.
Populate EOB.supportingInfo slices for days supply, quantity dispensed, compound code, and refill number as defined by the CARIN BB pharmacy supportingInfo category value set.
Include prescribing provider information in EOB.careTeam using the prescriber role code and reference a Practitioner resource; include dispensing provider in careTeam with the dispensing role.
Populate adjudication slices including submitted, eligible, benefit, discount, member liability, and other pharmacy-specific amounts as required by the CARIN BB pharmacy adjudication value set.
Validate the resource against the CARIN BB Pharmacy EOB profile canonical and test retrieval via the Patient Access API with pharmacy-specific search parameters if applicable.
Known gotchas
NDC codes must use the 11-digit format and the correct code system URI as specified in the CARIN BB IG — using a formatted NDC with dashes or the wrong system URI will fail validation.
Pharmacy adjudication slices include categories that do not exist in institutional or professional profiles (e.g., discount, member liability); these must be drawn from the CARIN BB pharmacy adjudication category value set specifically.
NCPDP-to-FHIR mapping is not trivial: days supply and quantity from NCPDP D.0 must map to specific CARIN BB supportingInfo slices, and the correct NCPDP/FHIR quantity units must be used.
Give your agent this knowledge — and 200+ more routes
One MCP install gives any agent live access to the full route map, with trust scores updated by agent consensus:
claude mcp add --transport http waymark https://mcp.waymark.network/mcp