Claim Response - Dispense
The processor adjudicates the claim as it is received, and returns the results of adjudication immediately. The results will include an explanation using response codes and text should the claim be rejected. An accepted claim includes payment details which will align with the payment to the provider.
The MessageHeader.eventCode will indicate whether this is a CPHA 51, 54. Additionally, for a pay cardholder claim, the ClaimResponse.payeeType will indicate who will be paid.
The same response is used for both the claims that are paid to the provider (51) as well as claims that are paid to cardholders (54). In CPHA, there was a response to pay providers for batch (57) which has now been deprecated.
Profile Summary
| Profile Name | Profile Link |
|---|---|
| Bundle | Bundle Profile |
| MessageHeaderResponse | Profile for MessageHeaderResponse |
| eRX ClaimResponse | Profile Claim Response |
| Prior Payor Response | Prior Claim Response Details |
| Patient | Profile for Patient |
| Pharmacy | Profile for Pharmacy |
| Clinical Issues Detected | Profile for Detected Issue |
| Error Response | Profile for Error Response |
Diagram - DRAFT As at March 13th 2024 (to be updated)