Operation Overview
This capability is invoked by using the $daily-totals operation or the $daily-details operation. These are designed as a custom operations rather than a query because key data in the message header can be re-used in an operation, which is more efficient for mapping to CPHA3.
The operation is invoked using an HTTP GET and responds with either an OperationOutcome (if errors exist) or a Parameters OUT instance containing the result.
The Daily Totals and Daily Details use the same Parameters IN resource, Bundle and Message Header Request profiles. The responses, Parameters OUT are different.
| Custom FHIR Operation | Definition | Response |
|---|---|---|
| [base]/$daily-totals | Bundle with Message Header, event.type = 30 and focus= profile-parameters-daily-totals-details-IN. | Bundle, Message Header response, event type=80, Profile URL, focus= profile-parameters-daily-totals-OUT Totals by Date |
| [base]/$daily-details | Bundle with Message Header, event.type = 31, focus= profile-parameters-daily-totals-details-IN | Bundle, Message Header response, event type=81, Profile URL, focus= Parameters:Out |
Message Overview
Daily Totals Request - 30
The provider requests totals accumulated by the processor for a specific adjudication date for an IIN, IIN and Carrier, or IIN, Carrier and Group.
This capability is invoked by using the $daily-details request. The operation is invoked using an HTTP GET and responds with either an OperationOutcome (if there were errors) or a Parameters OUT instance containing the result.
The request is identical to the Daily Details request in structure but it is distinguished by a unique transaction identifier (MessageHeader.event id).
New functionality available in FHIR is found here
Daily Totals Response - 80
The response to a Daily Totals request provides a summary of a given day's activities.
Adjudication Detail Request - 31
The purpose of this transaction is to obtain details of claims and reversals for a period of time during, or for an entire adjudication date for the purpose of resolving an unexplained variance between accumulated daily totals received from the processor and the provider's record for the same period of time.
This capability is invoked by using the $daily-details operation. This is an operation rather than a query because key data in the message header can be re-used in an operation, rather than a straight query on existing records. The operation is invoked using an HTTP GET and responds with either an OperationOutcome (if there were errors) or a Parameters OUT instance containing the result.
The request is identical to the Daily Totals request in structure but it is distinguished by a unique transaction identifier (MessageHeader.event id).
New functionality available in FHIR is found here
Adjudication Detail Response - 81
The response provides details of claims and reversals for a period of time during, or for an entire adjudication date for the purpose of resolving an unexplained variance between accumulated daily totals received from the processor and the provider's record for the same period of time.
Profile Summary
| Profile Name | Profile Link | Notes |
|---|---|---|
| Bundle | Bundle Profile | Used for all PCS FHIR Messages |
| MessageHeaderRequest | Profile for MessageHeaderRequest | Used for all request messages in PCS FHIR |
| MessageHeader Response | Profile for MessageHeaderResponse | Used for all request messages in PCS FHIR |
| Parameters IN - Daily Totals & Details Request | Parameters:IN | The same profile is used for both the Daily Totals and the Details Request. |
| Parameters OUT - Daily Totals Response | Daily Totals Parameters:OUT | |
| Parameters OUT - Adjudication Details Response | Adjudication Details Parameters:OUT | Profile is under development); |
| OperationOutcome | OperationOutcome | Standard FHIR profile used for conveying errors or warnings |