Event /Message ID FINAL
In FHIR, this is the MessageHeader.event.code. Both the system and code will be conveyed in the message instance. The Message Header.event code will identify the transaction type being processed. The list of transaction codes and mappings to CPHA follow:
Event Codes used in FHIR Messages
| 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 |
| FHIR Response Event Code | CPHA Trxn Code | Description |
|---|---|---|
| 52 | New - not in CPHA | Response to a pay provider or pay cardholder claim for a professional services claim. |
| 51 | 51 and 54 | Response to a pay provider or pay cardholder claim (formerly CPHA 54) for a dispense |
| 61 | 61 and 64 | Reversal Transaction Response to request for reversal of a pay provider claim or a pay cardholder claim (formerly CPHA 64) which was adjudicated |
| 80 | 80 | Response to a transaction requesting the accumulated totals for a specified adjudication date |
| 81 | 81,82,83 | Response Adjudication Details |
Deprecated CPHA3 codes
| CPHA Transaction Code | Description | Notes |
|---|---|---|
| 57 | Response to a pay provider claim for batch adjudication | No requirement |
| 04 | Transaction with one (1) pay cardholder claim | FHIR - use 01 with payee indicator |
| 54 | Response to one (1) pay cardholder claim. | FHIR use 51 |
| 67 | Response to request for reversal of a pay provider claim that has been captured for batch processing. | Deprecated, no requirement in FHIR |
| 64 | Response to a request for a reversal of a pay cardholder claim | FHIR use 61 |
| 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). | Included in 31 |
| 33 | Transaction requesting a detailed record of reversals, for up to 14 consecutive reversals, for claims processed prior to the adjudication date specified in this request (for Carrier ID and Group # if indicated). | Included in 31 |
| 82 | Response to a request for a detailed record of reversals of same date claims | included in 81 |
| 83 | Response to a request for a detailed record of prior date claims | included in 81 |