Old Material to be removed
CPHA Daily Totals Request - FHIR Mapping
This is included for discussion purposes only and will be removed once the new FHIR message is approved. The following outlines the existing data elements in the response message. As we migrate to FHIR, we will use the Message Header with the Parameters resource. The message header will be consistently used across all messages. Usage on some elements below to be discussed
| Existing Field Name | CPHA FIELD # | STATUS | FHIR | DESCRIPTION | |
|---|---|---|---|---|---|
| IIN | A.01.01 | M | MessageHeader | Issuer Identification Number identifies issuer of benefit card N 6 | |
| Version Number - Obsolete | A.02.03 | M | Corresponds to CPhA Pharmacy Claim Standard version numberused to transport this messageN 2 Current version # is "03" | ||
| Transaction Code | A.03.03 | M | MessageHeader | Identifies purpose of transaction A / N 2 30=transaction requesting the accumulated totals for specified adjudication date (for Carrier ID and Group # if indicated) |
|
| Provider SoftwareID | A.04.03 | M | MessageHeader | Identifies computer system in pharmacy A / N 2 See Terminology section for codes. | |
| Provider Software Version | A.05.03 | M | MessageHeader | Identifies version of provider software A / N 2 | |
| Active Device ID - Obsolete-LL | A.07.03 | O | Provides active device identification code A / N 8 | ||
| Pharmacy ID Code | B.21.03 | M | MessageHeader | Pharmacy identification code A / N 10 | |
| Provider Transaction Date | B.22.03 | M | Date Range Parameter | The date on which the provider sends the request N 6 YYMMDD, established for the time zone in which the provider is located at the time that the request for totals or details is transmitted. | |
| Trace Number | B.23.03 | O | discuss | The unique number produced sequentially by the Provider for each transaction transmitted by the provider N 6 | |
| Carrier ID | C.30.03 | O | Parameter | Identifies the plan type or benefit program A / N 2 The provider may utilize this field to identify a particular plan within an IIN to obtain more precise summaries, if payments are issued by carrier ID, or to obtain more concise detailed records from adjudicators who segregate accounts by carrier ID. | |
| Group Number or Code | C.31.03 | O | Parameter | This is a number or code assigned by the plan administrator, payor, processor or benefit card issuer to identify a specific group of benefit recipients within a carrier (Field C.30.03) designation A / N 10 See Section A for added information. A further breakdown of a summary or detailed record than is available from carrier ID may be obtainable from some adjudicators who use a group number or code to identify a significant number of beneficiaries (e.g. when a carrier ID contains less than 10 group designations). | |
| Adjudication Date | F.90.03 | O | Parameter | The adjudication date assigned to claims and reversals, at the time of processing, for which the totals (code 30) and the claims/reversal details (code 31) are being requested N 6 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 a closed adjudication date during the last 6 days. | |
| Beginning of Record | F.91.03 | O | discuss | This is the last prescription number which precedes the prescription at which the detailed record being requested begins. A provider who requests a detailed record that begins at the time of opening, on an adjudication date, will indicate "0" (zero) as the "last prescription number". In a request for a time period during the day the "last prescription number" will refer to the last prescription which was filled or reversed before the transaction at which the requested record begins. The processor who receives the request will identify the exact time,during the adjudication date, at which the transaction on the prescription number referred to occurred and will return a detailed record of the first 13 transactions (claims and reversals) which follow or until the "End of Record" (Field F.92.03) has been reached, whichever occurs first. The provider may continue to request packets of 13 transactions by repeating the procedure, using the last prescription number in the previous packet, until the "End of Record" or the record of the last transaction for the adjudication date has been received. | |
| End of Record | F.92.03 | O | discuss | This is the number of the last prescription to be included in the detailed record being requested N 9 The number of the last prescription may refer to either a claim or a reversal. If this field is blank, the "End of Record" will be the last transaction submitted on an adjudication date. |
CPHA Response (80) --- can remove - KEEP FOR REVIEW WITH TWG
Response to the GET Totals Operation, requesting the accumulated totals for a specified adjudication date.
The processor will maintain a series of totals, the counts of claims and $-fields, which have been accumulated during an adjudication date. These totals will contain the information provided for in Fields G.41.03 through to G.48.03. The totals are used for electronic reconciliation.
The processor will respond (Field E.05.03) to provide accumulated daily totals for the adjudication date requested or to advise that the request has been rejected. Accumulated daily totals will include the totals and any of the applicable information from fields G.49.03 through G.52.03 of the requested adjudication date. If the request is rejected, the advice (Code R-Field E.05.03) will be followed by a response code (Field E.06.03) to indicate the reason for rejection.
The structure definition is found here: *Anne to build this based on the table below, once TWG agrees http://pharmacyeclaims.ca/fhir/StructureDefinition/profile-parameters-totals-response
Response Parameters
| FIELD NAME - FHIR PARAMETER NAME | FIELD # | DESCRIPTION | FORMAT LENGTH | CODE VALUES – ADDED INFORMATION |
|---|---|---|---|---|
| Adjudication Date | E.01.03 | This is the date assigned by the Processor. See code values in Field E.01.03 (Section E) | N 6 YYMMDD | See Field E.01.03 (Section E) regarding beginning and conclusion |
| Trace Number | E.02.03 | The number assigned, by the provider, to the transaction to which this response applies N 6 | ||
| Transaction Code | E.03.03 | This identifies the purpose of the transaction being responded to (see APPENDIX 1) | A / N 2 | 80=response to a transaction requesting accumulated totals for a specified adjudication date. |
| Reference Number | E.04.03 | This is the internal reference number assigned, by the processor to the request for daily totals | N 9 | |
| Response Status | E.05.03 | This indicates the status of the request transmitted | A 1 | Y=accumulated daily totals R=request rejected |
| Response Codes | E.06.03 | (updated April 1995) Codes to define esponses that identify errors and other reasons that may cause the request to be rejected or the response to be incomplete. Field length of 10 will accommodate 5 response codes per request |
A / N 10 | These are, wherever possible, consistent with codes in Field E.06.03.01=IIN error 02=version number error *03=transaction code error 04=provider software ID error 21=pharmacy ID code error 22=provider transaction date error 23=trace number error 30=carrier ID error 31=group # error 90=adjudication date error D9=call adjudicator |
| Total Claims Approved | G.41.03 | Total number of pay provider claims accepted for payment for the requested adjudication date | N 4 | For transaction code 51 (in Field E.03.03) in Section E with response status A and B (in Field E.05.03) in Section E. |
| Total Payable by Carrier | G.42.03 | The total payable to the provider, by the carrier, for the requested adjudication date | D 8 | For transaction code 51 (in Field E.03.03) in Section E with response status A and B (in Field E.05.03) in Section E. |
| Total Reversals | G.43.03 | The total number of reversals processed against pay provider claims approved on the adjudication date to which the response refers | N 3 | For transaction code 61 (in Field E.03.03) in Section E with response status V (in Field E.05.03) in Section E. |
| Total Value of Reversals | G.44.03 | The total value of reversals processed against pay provider claims approved on the adjudication date to which this response refers | D 8 | For transaction code 61 (Field E.03.03) in Section E with response status V (in Field E.05.03) in Section E. |
| Total Prior Reversals | G.45.03 | The total number of reversals processed on the adjudication date which refer to pay provider claims processed on a previous adjudication date | N 3 | For transaction code 61 (Field E.03.03) in Section E with response status V (in Field E.05.03) in Section E. |
| Total Value of Prior Reversals | G.46.03 | The total value of reversals processed on the adjudication date which refer to pay provider claims processed on a previous adjudication date | D 8 | For transaction code 61 (Field E.03.03) in Section E with response status V (in Field E.05.03) in Section E. |
| Total Claims Captured for Batch Processing | G.47.03 | The total number of pay provider claims captured by the adjudicator for batch processing on the requested adjudication date | N 4 | For transaction code 57 (Field E.03.03) in Section E with response status C (Field E.05.03) in Section E. |
| Total Reversals Captured for Batch Processing | G.48.03 | Total number of reversals of pay provider claims captured by the adjudicator for batch processing on the requested adjudication date | N 4 | For transaction code 67 (Field E.03.03) in Section E. |
| Date of Deposit | G.49.03 | Date upon which the banking institution is expected to post the deposit to the providers account | N 6 YYMMDD | |
| Transaction Fees | G.50.03 | Total value of transaction fees | D 6 | Transaction fees are charged back to the provider. |
| GST charged on Transaction Fees | G.51.03 | The applicable amount of GST for the transaction fee charged | D 6 | This relates to value added services (e.g. first day deposit) for which a fee is charged to the provider. |
| Amount of Deposit | G.52.03 | The amount of the EFT deposit for the adjudication date concerned | D 8 | |
| Total Claims Captured for Reimbursement to Card Holder | G.53.03 | Total number of claims captured by the adjudicator for reimbursement to cardholders on the requested adjudication date | N 4 | For transaction code 54 (Field E.03.03) in Section E |
remove this later
Existing CPHA request to be reviewed by TWG
| FIELD NAME | FIELD # | FHIR | Notes |
|---|---|---|---|
| A.01.01 | IIN | Message Header.Destination | |
| A.02.03 | Version Number | DEPRECATE | |
| A.03.03 | Transaction Code | MH.event code or DEPRECATE if we agree this is not mappable? | 31=transaction requesting a detailed record of claims, for up to 14 consecutive claim transactions, on a specified adjudication date (for Carrier ID and Group # if indicated) 32=transaction requesting a detailed record of reversals, for up to 14 consecutive reversals, of claims processed on a specified adjudication date (for Carrier ID and Group # if indicated) 33=transaction requesting a detailed record of prior reversals, for up to 14 consecutive reversals, of claims processed prior to the adjudication date specified in this request (for Carrier ID and Group # if indicated) |
| A.04.03 | Provider Software ID | Message Header | |
| A.05.03 | Provider Software Version | Message header | |
| A.07.03 | Active Device ID | DEPRECATE | |
| B.21.03 | Pharmacy ID Code | MH.Author | |
| B.22.03 | Provider Transaction Date | Parameter | YYMMDD, established for the ime zone in which the provider is located at the time that the request for totals or details is transmitted |
| B.23.03 | Trace Number | Parameter or DEPRECATE? | |
| C.30.03 | Carrier ID | Parameter.Part | |
| C.31.03 | Group Number or Code | Parameter.Part | |
| F.90.03 | Adjudication Date | DO WE NEED THIS? HOW DIFFERENT FROM PROVIDER TRANSACTION DATE?? | 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. |
| F.91.03 | Beginning of Record | ||
| F.92.03 | End of Record |