Daily Totals - Message Structure
The request and response messages are backward compatible transaction with new features added. All implementers will need to support the new Operation and it is encouraged to support this from the MVP implementation stage. Vendors will need to know which adjudicators support the new queries for Totals and Details and timeframes for implementing will vary across adjudicators. If adjudicators have not fully implemented the new features (eg they are in the initial MVP stage and mapping), they are permitted to reject as specified in the mapping rules below. Adjudicators will decide if mapping from CPHA is prefereable over natively supporting this transaction within their systems during the MVP stage as the effort of mapping may not be worth it.
The new features have been added as are important to the software vendors in order to streamline the process for the users. As such it is expected that adjudicators will implement the new parameters and support for the native FHIR query as soon as possible.
The new query response is more flexible in that an adjudicator can return all totals by adjudicator, or at the carrier and/or group level if desired. The response can include totals over multiple dates as requested in the query. Further, the result set is much larger than the CPHA transaction allows and this should reduce the number queries that are required in order for a pharmacy to obtain the data that is needed.
Profile Summary
| Profile Name | Profile Link |
|---|---|
| Bundle | Bundle Profile |
| MessageHeaderRequest | Profile for MessageHeaderRequest |
| Parameters Response | Parameters:IN |
| Parameters Response | Parameters:OUT |
Daily Totals Request Message Structure
| Resource | Cardinality | Description | Notes |
|---|---|---|---|
| Bundle | 1..1 | Type=message; MH must be the first bundle entry | |
| MessageHeader | 1..1 | Messaging header, Request profile | The focus of the message will be the Parameters IN resource |
| Parameters | 1..1 | The parameters IN; mandatory |
Daily Totals Response Message Structure
| Resource | Cardinality | Description | |
|---|---|---|---|
| Bundle | 1..1 | Type=message; MH must be the first bundle entry | |
| MessageHeader | 1..1 | Messaging header, response profile | The focus of the message will be the Parameters resource or Operations Outcome if errors should occur. |
| Parameters | 0..1 | The parameters OUT; mandatory for all successfuly queries | |
| OperationOutcome | 0..1 | This resource is used when there are errors found in the request |
CPHA Definition versus FHIR Definition
The definition of the transaction has changed, as follows:
|Trxn|CPHA Definition|FHIR Definition
|-
|30|Transaction requesting the accumulated totals for specified adjudication date (for Carrier ID and Group # if indicated)|Transaction requesting the accumulated totals for a given date range (for Carrier ID and Group # if indicated)
|80| response to a transaction requesting accumulated totals for a specified adjudication date.| response to a transaction requesting accumulated totals for a specified adjudication date range period