Daily Totals Operation

This capability is invoked by using the $daily-totals 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 Adjudication Details request in structure but it is distinguished by a unique transaction identifier (MessageHeader.event id). The queries will be executed using a custom FHIR Operation, "$daily-totals" or "$daily-details" which also distinguishes the type of request.



The Daily Totals Request in FHIR is a new request message that will replace the CPHA Transactions 30, 31 and 32. This will use the MH.event type 30 which is the same transaction type as CPHA 30.

This new Request for the Accumulated Totals is for a specific adjudication date, with a paramater that allows for specific Carriers and/or Groups to be either included or excluded, as indicated in the request. Though structurally different, this fulfils the same business requirement in a modernized fashion. Note: The query is being re-structured while retaining mappability to the existing CPHA transactions.

This FHIR message covers all of the existing functionality with the following improvements:

  1. The 14 day restriction has been removed. While the time period is open ended, the maximum recommended period is 31 days which all adjudicators are expected to support. Each implementer will communicate their supported time period.
  2. The FHIR structure specifies an "include" or "exclude" rule that allows vendors to specifically request that one or more carriers and/or groups be included or excluded in the result set.
  3. Paging is not supported once FHIR is natively supported by the sending and receiving applications; all results will be returned in a single response message for FHIR.
  4. Backward compatibility to CPHA is maintained; however the parameters for beginning and end records will be phased out over time as implementers move to FHIR.
  5. The result set will include both claims and reversals which supports mappings to CPHA results; data that is ireelevant may be ignored.