Phase 1 Overview - MVP

The first phase of Implmentation is being referred to as the "MVP Stage", or "Minimum Viable Product". The goal of the MVP phase is to move implementers on to the new PCS FHIR standard with minimal effort by making the majority of new fields optional during this phase. It is expected that many implementers will map between CPHA3 and FHIR during this phase, rather than to natively support FHIR.

Implementers may choose to "send" additional “optional” or “recommended” data (eg compound details) if they are able to do so, however there is no expectation that the data will be consumed by the receiver during the initial phase, unless this is coordinated/communicated between implementation partners. A complete list of new fields and functionality, along with the MVP scope is included in the pages which follow.

The second phase includes implementation of the remaining functionality as it applies to that organization’s business. For instance, if pharmacy services are not a part of benefits, they need not be implemented.

This section identifies all of the new fields and functionality and provides an MVP Scope, which indicates whether or not it is included as part of the Scope for MVP. Additionally, sender and receiver responsibilities are outlined.

Message Identifiers (Event Codes) used in PCS FHIR

All message types are mandatory for FHIR during the MVP Phase

FHIR Request Event Code	CPHA Trxn Code	Description	Response
01	01	Claim Request for Dispense transaction with one (1) pay provider claim or pay cardholder claim for a dispense	51
02	NEW - not in CPHA	Professional Services transaction with one (1) pay provider or pay cardholder claim	52
11	11	transaction for reversal of either a dispense or professional services claim	61
30	30	Request for Daily Totals	80
31	31,32,33	Request for Adjudication Details	81