Claim Reversal Response Message Structure

In FHIR, there is only a single type of Reversal Response that is used when the claim reversal has been processed successfully, and the distinction of type of reversal is indicated as a response parameter. This FHIR message maps to both the 61 and 64 transactions from CPHA. This transaction is used to request a reversal for both dispense and professional services claims.

FHIR Message Structure

The follow diagram depicts the high level structure, showing all resources that are included in the message and how they are linked together.

Profile Name	Profile Link
Bundle	Bundle Profile
MessageHeaderRequest	Profile for MessageHeaderRequest
Parameters OUT	Reveral Parameters:OUT