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.
Daily Total and Details Request Mapping
| FIELD NAME | FIELD # | FHIR | Notes |
|---|---|---|---|
| A.01.01 | IIN | Message Header.Destination | |
| A.02.03 | Version Number | N/A | DEPRECATED |
| A.03.03 | Transaction Code | MessageHeader.event code = 31 for details | |
| A.04.03 | Provider Software ID | MessageHeader.source.software | |
| A.05.03 | Provider Software Version | MessageHeader.source.version | |
| A.07.03 | Active Device ID | MessageHeader.sender.display | |
| B.21.03 | Pharmacy ID Code | Claim->Organization.identifier.value | |
| B.22.03 | Provider Transaction Date | Bundle.timestamp | YYMMDD, established for the time zone in which the provider is located at the time that the request for totals or details is transmitted |
| B.23.03 | Trace Number | Parameters.parameter:TraceNumber | Limited to 6N today; unlimited in FHIR |
| C.30.03 | Carrier ID | Parameter.Part | Mapping only when Results Rule = Include |
| C.31.03 | Group Number or Code | Parameter.Part | Mapping only when Results Rule = Include |
| F.90.03 | Adjudication Date | Parameters.parameter:AdjudicationDate Includes support for start and end dates and includes time This is NOT MAPPABLE when start and end dates are different. |
YYMMDD assigned by the processor in Field E.01.03 at the time the claims were adjudicated or the reversals were processed. Request may be for current day's totals or detail or for closed adjudication date during the last 6 days. |
| N/A | Not in CPHA | Parameters.parameter:StartDate | |
| N/A | Not in CPHA | Parameters.parameter:EndDate | Adjudicators must communicate support for single day or multiple days and whether variances in time are supported (replacing current mechanism). Alternatively, adjudicators may reject if not same as start date. Sending systems should recognize what adjudicators support FHIR |
| F.91.03 | Beginning of Record | Parameters.parameter:BeginningOfRecord | Only supported for backward compatibility |
| F.92.03 | End of Record | Parameters.parameter:EndOfRecord | Only supported for backward compatibility |
| N/A | Not in CPHA | Parameters.parameter:14RecordRestriction | Mapping & Backward compatibility. Indicates to adjudicator that sender is resticted to 14 records in the result set, eg when mapped from CPHA |
| N/A | Not in CPHA | Parameters.parameter:ResultsRule | Mapping is only supported when code = "include". Adjudicators should communicate whether mapping is in place or whether new exclude functionality is supported Specifies the type of response desired. Code= All Return everything (Carrier/Group list MUST be blank) Or vendors may set code=Include , Return only carrier/groups that are specifed in the list |
**FHIR Profiles
ParametersIn: (https://simplifier.net/pharmacyeclaim/dailytotalsdetailsparametersin)