Adjudication Details Response
Transaction response to a query for a detailed record of claims for up to 14 consecutive transactions, for a specified adjudication date (for Carrier ID and Group # if indicated). This returns a detailed record of accepted claims.
Discussion Items
The profile /message has not been fully developed; need to resolve discussion items first.
| FIELD NAME | FIELD # | FHIR | Notes |
|---|---|---|---|
| E.01.03 | AdjudicationDate | This is the date assigned by the processor. | |
| E.02.03 | TraceNumber | Parameters.parameter:TraceNumber | 6N max in CPHA; unlimited in FHIR is this a mapping issue? |
| E.03.03 | Transaction Code | MessageHeader.event.code = 81 | |
| E.04.03 | Reference Number | Parameters.parameter:ReferenceNumber | This is the internal reference number assigned, by the processor to the request for daily totals |
| E.05.03 | Response Status | Parameters.parameter:ResponseStatus | This indicates the status of the request transmitted Z=detailed record as requested R=request rejected |
| E.06.03 | Response Codes | Parameters.parameter:ResponseCodes | |
| H.65.03 | Number of Detail Records | Total number of detail records included | |
| H.66.03 | Current Rx Number | Prescription Numbers (from Field D.55.03) of the first claim or reversal and all subsequent claims or reversals contained in this response | |
| H.67.03 | Amount Payable/Reversed | Value of individual claims or reversals as identified by prescription numbers in Field H.66.03 | |