11-Reversal Request - New Fields

The Reversal Request includes most of the data that is present in the CPHA3 request. Only optional elements relating to cardholder information have been eliminated. Only the Client ID and JHN are supported in the message as optional elements. There is only one new field that is not present in CPHA3 today as shown below.

CPHA3 Reversal Request vs PCS FHIR

The provider requests reversal of a claim and transmits the mandatory elements of Sections A, B, C, the current prescription number (Field D.55.03) from Section D, and the adjudication date (Field E.01.03) for the claim to be reversed.

As there was a desire to streamline this message, section C (eg Carrier ID, Group ID, Client ID, etc) of CPHA3 has not been included in this reversal request. Many of these are optional in the CPHA3 specification. The PCS FHIR message does however, include enough data that should it be required, the adjudicator can do an internal query to gather this data.
Please refer to the mapping section of this document for mapping details

Refer to Reversal Message Mappings for full details.

Feature	MVP Scope	Details	POS - Sender Responsibility - MVP	Adjudicator - Receiver Responsibility - MVP
REVERSAL - PARAMETER-IN	Reversal Request
NEW FIELD Reference Number	OPTIONAL	New data element; present in adjudication result. BENEFIT:Enhances processing capability with new information.	OPTIONAL - may send if possible	OPTIONAL - no expectation to consume this data