61 - Reversal Response - New Fields
There are no new data elements (aka fields) being introduced with PCS FHIR for the Reversal Response. Not all data elements in the reversal response are mappable to/from CPHA3 data as there was an effort to streamline the response message. As such, surplus fields that are not required for reversal purposes have been excluded. Most if not all are optional in CPHA3.
CPHA3 Reversal Response Definition
The reversal may be for a claim accepted and adjudicated on the current or a previous adjudication date. The processor accepts or rejects the request for reversal and advises the provider via a response status (Field E.05.03). An accepted request will result in the reversal of the claim and on adjustment of the adjudication date totals. A rejected request advice will be followed by a response code (Field E.06.03) or a detailed response (Field E.20.03) to indicate the reason for rejection of the request.
