02 - Proff Services - New Transaction

Under Construction

The overall structure of the message is identical to the Claim for a Medication Dispense. Only changes that are specific to Professional Services claims are outlined below. Many resources are identical, including Bundle, Message Header, Patient and Coverage resources.

The Professional services claim request does not include dispense data in the request, and it may include informational medication information when the service relates specifically to a medication. The Pharmacist may be identified as the Prescriber in some cases, eg Prescription Adaptions

Feature	Details	POS - Sender Responsibility	Adjudicator - Receiver Responsibility
NEW MESSAGE New Professional services message	A new transaction to support the Professional service. Mandatory support from onset; Adjudicator must determine fixed values that are in CPHA3 but not in FHIR when mapping request
STREAMLINED CLAIM REQUEST	Unnecessary fields have been removed from this message and additional information specific to services has been added BENEFIT: Additional information should reduce audits and clawbacks	All new fields are optional though must be populated where data is available	Should consume as required
NEW FIELD ORIGINAL DIN
NEW FIELD SUBSTITUTED DIN
NEW FIELD Prescriber Contact Indicator	Prescriber Contact Indicator
NEW FIELD Notes, Comments
NEW FIELD Adjusted/modified Dosage/Formulation
NEW FIELD Originating Prescriber ID
NEW FIELD Reason Code	Example: increase in dosage, side effects (not an adaption in Alberta), etc
NEW FIELD Adapted DIN or dosage/frequency	Must be sent for Prescription Adaptions
NEW FIELD Clinical Notes
NEW FIELD SERVICE CODE
NEW FIELD

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