Event Codes /CPHA Code Mapping
The Message Header.event code will identify the transaction type being processed. The list of transaction codes and mappings to CPHA follow:
| Event Code | CPHA Trxn Code | Description | FHIR Response |
|---|---|---|---|
| FHIR Requests | |||
| 01 | 01- Pay provider claim | Dispensed Medication Claim. Transaction with one (1) pay provider claim or pay cardholder claim for a dispense | 51 |
| 02 | NEW - not in CPHA | Professional Services Claim. Transaction with one (1) pay provider or pay cardholder claim for Professional Services | 52 |
| 11 | 11 - Reversal | 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 Summary | 81 |
| FHIR Responses | |||
| 51 | 51 and 54 | Response to a pay provider or pay cardholder claim (formerly CPHA 54) for a dispense | |
| 52 | New - not in CPHA | Response to a pay provider or pay cardholder claim for a professoinal services claim | |
| 61 | 61 and 64 | Response to request for reversal of a pay provider claim or a pay cardholder claim (formerly CPHA 64) which was adjudicated | |
| 80 | 80 | Response for Daily Totals | |
| 81 | 81,82,83 | Response Adjudication Summary |
Deprecated Transaction Codes - CPHA3
The functionality provided in CPHA will continue to exist in FHIR for the following transactions, though the transaction codes themselves will be deprecated.
| CPHA Transaction | Replaced by FHIR |
|---|---|
| 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) |
| 32 | Adjudication Details |
| 33 | Adjudication Details |
| 82 | Adjudication Details Response |
| 83 | Adjudication Details Response |
Deprecated CPHA Transactions, No FHIR Replacement
No mapping will be available for the following transactions that are deprecated as they are not in use today. As such these will not be migrated to FHIR.
| CPHA Transaction |
|---|
| 40 - Beneficiary Information Update |
| 67 - Reversal Response Batch Processing |
| 57 - Response to a pay provider claim for batch adjudication |