Get Totals and Details Request FHIR-CPHA3
The GET Totals Request and GET Details Request are not fully mappable to CPHA3. This decision was made as the PCS Standards Commitee beleives it is advantageous to streamline the existing CPHA3 queries and that was not possible to achieve while allowing full mapping capabilities.
The Bundle and Message Header request map to Section A (Message Destination, Purpose and Control Elements) in CPHA3. They are identical to those in the Claim Request.
IN Parameters:Request & CPHA Mappings
| Parameter | Part | Name | Cardinality | Type | Details | CPHA 3 Mapping Rules |
|---|---|---|---|---|---|---|
| Parameter | Trace Number | 1..1 | string limited to 6N today | FHIR will support unlimited | B.23.03 | |
| Parameter | Start Date | 1..1 | dateTime | F.90.03 Adjudication Date | ||
| Parameter | End Date | 1..1 | dateTime | New; reject if not same as start date; configurable by adjudicator. Sending systems should recognize what adjudicators support FHIR | ||
| Parameter | Results Rule | 1..1 | Code | Code= Include/Exclude/All All=Return everything (Carrier/Group list MUST be blank) Include=Return only carrier/groups that are specifed in the list Exclude=Return everything EXCEPT carrier/groups that are specified in the list |
New functionality; not mappable; sending systems must only use a value of all* to return everything; else receiving systems may reject with an operation outcome detailing the issue | |
| Parameter | Adjudicator ID | 1..1 | identifier | value also in message header | Message Header.Destination. | |
| Parameter | Carrier/Group | 0..* | N/A | See Part - Carrier ID + optional Group ids | This is not supported in CPHA3; sending systems should recognize and sent only to adjudicators who support PCS FHIR | |
| Part | Carrier ID | 0..1 | string | C.30.03 Carrier ID | ||
| Part | Group ID | 0..1 | string | C.31.03 Group ID |