Complete Terminology List
The following table provides an overview of maintenance. The vast majority of Value sets have a binding strength of Extensible, which provides flexibiliy to add codes as needed. Code systems should be specified in the message instances where possible, though they are not typically mandatory due to backward compatibility with CPHA3 messaging.
Note: The following list must be validated during the Trial Use Review Period in early 2026.
| Value Set | FHIR Profile | Binding | Owner | Maintenance Requirements | Code System | Fixed Value |
Notes |
|---|---|---|---|---|---|---|---|
| Assigning Authorities Pharmacist | Claim.prescriber | Extensible | CPHA | Medium | |||
| Adjudication Category | ClaimResponse.item. adjudication.category |
extensible | CPHA | low | http://pharmacyeclaims.ca/FHIR/CodeSystem/adjudication-category-codes | ||
| Alert Codes | Response.item.ajdudication. ClinicalAlertCode |
Extensible | CPHA | Medium | http://pharmacyeclaims.ca/FHIR/CodeSystem/alert-codes | ||
| Canadian Jurisdiction/Province Code | MH.source.ext-SourceProvinceCode | Required | External | Low | http://canadapost.ca/CodeSystem/ProvinceCodes | ||
| ClaimResponse.item.adjudicationCode | ClaimResponse.item.adjudication | Extensible | Low | http://pharmacyeclaims.ca/FHIR/CodeSystem/ *http://pharmacyeclaims.ca/FHIR/CodeSystem/adjudication-item-code |
|||
| Claim Response Outcome Code | ClaimResponse.outcome | Extensible | CPHA | low | TBD | ||
| CoverageType | Coverage | Extensible | CPHA | Low | http://pharmacyeclaims.ca/FHIR/CodeSystem/coverage-type | No | |
| Dispense Type | dispense.type | extensible | HL7 | Low | http://terminology.hl7.org/CodeSystem/v3-ActCode | Yes | |
| Dispense Claim Item Detail codes | extensible | PCS | Low | ||||
| Diagnosis Code Systems | Diagnosis Code | Required | CPHA | Low | http://pharmacyeclaims.ca/FHIR/CPHA-diagnosis-ODB-reason-code http://pharmacyeclaims.ca/FHIR/CPHA-diagnosis-DND-eligible-medical-conditions http://hl7.org/fhir/sid/icd-9-cm http://hl7.org/fhir/sid/icd-10 |
||
| Dispensed Quantity Unit | Dispense.quantity, Claim.item.quanti | Extensible | CPHA | low | http://pharmacyeclaims.ca/FHIR/CodeSystem/IE-assigning-authority-protocol | ||
| DUR Codes | DetectedIssue.code | Extensible | CPHA | Low | http://pharmacyeclaims.ca/FHIR/CodeSystem/DUR-codes | ||
| New/Refill Code | MedicationDispense.type | Extensible | CPHA | Low | |||
| Event Code | MessageHeader.code | Extensible | PCS | Low | http://pharmacyeclaims.ca/FHIR/CodeSystem/event-code | ||
| Gender | Patient.gender | Required | HL7 | None | |||
| Intervention & Exception | Claim.item.modifier | Extensible | CPHA | Medium | http://pharmacyeclaims.ca/FHIR/CodeSystem/intervention-codes | ||
| HealthcareRole | Claim.careTeam.role | Extensible | FHIR | Low | http://pharmacyeclaims.ca/FHIR/CodeSystem/proff-role-codes | ||
| Intervention U Codes | Claim.detectedIssue.Mitigation.code | Extensible | CPHA | Medium | http://pharmacyeclaims.ca/FHIR/CodeSystem/mitigation-codes | ||
| Intervention C Codes | MedicationDispense. notPerformedReason |
Extensible | CPHA? | Medium | |||
| Message Version | MessageHeader.meta.tag | Extensible | PCS | Medium | http://pharmacyeclaims.ca/FHIR/CodeSystem/message-version | ||
| Not Performed Reason Intervention C |
Claim.item.modifier | Extensible | CPHA | Low | http://pharmacyeclaims.ca/FHIR/CodeSystem/intervention-codes http://pharmacyeclaims.ca/FHIR/CodeSystem/intervention-not-performed-reason |
||
| Medication Codes | Health Canada | Extensible | CPHA External | TBD | |||
| New Refill Code | Claim.type | Extensible | External | Low | http://terminology.hl7.org/CodeSystem/v3-ActCode | ||
| Note Type | ClaimResponse.processNote. language.coding.code |
Extensible | CPHA | Low | http://pharmacyeclaims.ca/FHIR/CodeSystem/note-type | ||
| Note Language | ClaimResponse.processNotes.language | extensible | CPHA | Low | http://pharmacyeclaims.ca/FHIR/CodeSystem/note-language | ||
| OrderableDrugForm | MedicationDispense.quantity | extensible | Infoway | Low | http://hl7.org/fhir/v3/orderableDrugForm https://fhir.infoway-inforoute.ca/CodeSystem/snomedctcaextension |
||
| Payee type Code | Claim.payee | Extensible | HL7 | Low | http://terminology.hl7.org/CodeSystem/payeetype | ||
| Provider Software ID | MessageHeader.software | Extensible | CPHA | Medium | http://pharmacyeclaims.ca/FHIR/CodeSystem/provider-software-codes | ||
| Prescriber ID Reference | Practitioner.identifier.system | Extensible | Infoway /CPHA |
Low | |||
| Product Selection Code | Claim.supportingInfo:ProductSelection | Extensible | PCS | Low | |||
| Relationship Code | Coverage.relationship | Required | HL7+CPHA | Low | http://terminology.hl7.org/CodeSystem/subscriber-relationship | ||
| Response Codes | ClaimResponse.item.adjudication: ResponseCodes |
Extensible | CPHA | Medium | http://pharmacyeclaims.ca/FHIR/CodeSystem/response-codes | ||
| Special Service Codes | Claim.item.modifier.coding: SpecialServiceCode |
Extensible | CPHA | Medium | http://pharmacyeclaims.ca/FHIR/CodeSystem/special-service-codes | ||
| Software Vendors PCS FHIR | Placeholder | Extensible | CPHA | medium | |||
| Supporting Information Codes | Claim.supportingInformationCategory | Extensible | CPHA | Low | http://pharmacyeclaims.ca/FHIR/CodeSystem/supporting-info-category-codes | ||
| Substitution Reason Code | Medication. | Extensible | PCS | Low | http://pharmacyeclaims.ca/FHIR/CodeSystem/product-selection | ||
| Claim Response Status | ClaimResponse.decision | Required | CPHA | None | http://pharmacyeclaims.ca/FHIR/CodeSystem/claim-response-status | ||
| Response Code - CodeSystems | ClaimResponse.item.adjudication: ResponseCodes.reason.coding.system |
Extensible | CPHA | Low | http://pharmacyeclaims.ca/FHIR/CodeSystem/code-system-values-for-response-codes | ||
| Reversal Response Codes | ClaimResponse.? | Extensible | CPHA | Low | http://pharmacyeclaims.ca/FHIR/CodeSystem/reversal-response-codes | ||
| Unlisted Compound | Claim.item.code | Extensible | CPHA | Medium | http:// pharmacyeclaims.ca/FHIR/CodeSystem/unlisted-compound-codes | ||
| Therapeutic Substitution Codes | Proff Services Claim. supportingInformation |
Extensible | PCS | Low | http://pharmacyeclaims.ca/FHIR/CodeSystem/therapeutic-substitution |
Sytem Identifiers - Fixed Values
The following identifiers have been created for use within the message specification in order to specify anidentifier system. These are "fixed values" that fall within the Pharmacy Claim Standard (pharmacyeclaims.ca) domain. The identifiers must be specified in the message.
No maintenance/changes will be required, though new ones may be added over time as necessary.
| System Identifier | Usage | Notes |
|---|---|---|
| http://pharmacyeclaims.ca/FHIR/CPHA-identifier/trace-number | Claim.identifier | Required for backward compatibility |
| http://pharmacyeclaims.ca/FHIR/CPHA-identifier/reference-number | ClaimResponse.identifier | backward compatibility |
| http://pharmacyeclaims.ca/FHIR/CPHA-identifier/IIN | MessageHeader.receiver | Required for backward compatibility |