Event /Transaction Code FOR REVIEW
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:
Codes used in FHIR Messages
| FHIR Event Code | CPHA Trxn Code | Description | Notes |
|---|---|---|---|
| 101 | 01 | transaction with one (1) pay provider claim or pay cardholder claim for a dispense | |
| 103 | NEW - not in CPHA | transaction with one (1) pay provider or pay cardholder claim for Professional Services | |
| 111 | 11 - Reversal | transaction for reversal of either a dispense or professional services claim | |
| 131 | New - not in CPHA | Response to a pay provider or pay cardholder claim for a professoinal services claim | |
| 151 | 51 and 54 | Response to a pay provider or pay cardholder claim (formerly CPHA 54) for a dispense | |
| 161 | 61 and 64 | Response to request for reversal of a pay provider claim or a pay cardholder claim (formerly CPHA 64) which was adjudicated | |
| 130 | 30 | Request for Daily Totals | |
| 180 | 80 | Response for Daily Totals | |
| 131 | 31,32,33 | Request for Adjudication Summary. | |
| 181 | 81,82,83 | Response Adjudication Summary |
Codes used in FHIR Operations
The following "event codes" will be conveyed as "Parameters" resource and used in the Operations that are defined to invoke these queries.
**Once FHIR profiles are established, the following will be updated
| FHIR Event Code | Description | Notes | |
|---|---|---|---|
| FHIR Parameter IN URL | Totals Request | ||
| FHIR Parameter OUT URL | Response to Totals Request | ||
| FHIR Parameter IN URL | Adjudications Details Request | ||
| FHIR Parameter OUT URL | Response to Adjudication Details | ||
| FHIR Parameter IN URL | Reversal Request | ||
| FHIR Parameter OUT URL | Reversal Response |