Adjudication Details Response
Out Parameters: Successful Response & CPHA Mappings
https://simplifier.net/pharmacyeclaim/dailytotalsparametersout
Response is a FHIR parameters instance with a MessageHeader.event code = 80.
Each record returned - group by date and trxn type (always return two records, one for 01 and one for 11. One record for each date that will return two rows.
Total Claims Captured for Batch Processing G.47.03 and Total Reversals Captured for Batch Processing G.48.03 have been deprecated as they are not being used by any adjudicators today.
| FHIR Parameter | Name | Part | Part2 | Cardinality | Type | Details |
|---|---|---|---|---|---|---|
| Parameter | 0..* | Repeats for each applicable date | ||||
| Parameter | Trace Number | 1..1 | identifier | also in message header | ||
| Parameter | Date | 0..1 | ||||
| Parameter | DateName | 1..1 | string | fixed value = StartDate | ||
| Parameter | Date | ClaimTotalPaid | ||||
| Parameter | Date | ClaimTotalPaidPatient | ||||
| Parameter | Date | Reversal Total | ||||
| Parameter | Date | Reversal Total Patient | ||||
| Parameter | Date | Prior Day Reversals | ||||
| Parameter | Date | Prior Day Reversals Patient | ||||
| Parameter | Date | Total Claims Approved | ||||
| Parameter | Date | Total Reversals | ||||
| Parameter | Date | Total Prior Reversals | ||||
| Parameter | Total Trxns Date Range | |||||
| Parameter | Reference Number | |||||
| Parameter | Response Status | |||||
| Parameter | Response Codes | |||||
| Parameter | Daily Totals By Date | |||||
| Parameter | Daily Totals By Date | |||||
| Parameter | Daily Totals By Date | Total Number Pay Provider | ||||
| Parameter | Daily Totals By Date | Total Amount Pay Provider | ||||
| Parameter | Daily Totals By Date | Total Number Reversals Pay Provider | ||||
| Parameter | Daily Totals By Date | Total Amt Reversals Pay Provider | ||||
| Parameter | Daily Totals By Date | Total Number Pay Cardholder | ||||
| Parameter | Daily Totals By Date | Total Amt Pay Cardholder | ||||
| Parameter | Daily Totals By Date | Carrier Number | ||||
| Parameter | Daily Totals By Date | Carrier Number | Group Number | |||
| Parameter | Date of Deposit | |||||
| Parameter | Transaction Fees | |||||
| Parameter | GST Transaction Fees | |||||
| Parameter | Amount of Deposit |
|Parameter|Results Rule|1..1|code|Add value set*|All, Include, Exclude, as per the request|New, not in CPHA
|Parameter|Reference Number|1..1|identifier||internal reference number assigned,by the processor to the request for daily totals|Reference Number E.04.03
|Parameter|Response Status|1..1|This indicates the status of the request transmitted Y=accumulated daily totals
R=request rejected|Response Status E.05.03|
|Parameter|Response Codes|1..5|Codes to define responses that identify errors and other reasons that may cause the request to be rejected or the response to be incomplete.|Response Codes E.06.03
|Parameter|Date|1..1|dateTime||Repeats for each date within the requested date range; one date record is returned for each date||
|Part|Trxn type|Value = 01 (Claim) or 02 (Reversal) or 03 (Prior Day Reversal)|
|Part|Total amount paid to patient|Not directly mappable; Set value = blank when not applicable, eg during MVP phase. Post MVP this must be populated properly
|Part|Total amount paid to pharmacy|Total Payable by Carrier G.42.03 or Total Value of Prior Reversals G.46.03 or Total Value of Reversals G.44.03|
|Part|Total number of trxn for this date|Map: Total Reversals G.43.03 OR Total Claims Approved G.41.03 or Total Prior Reversals G.45.03