MVP Scope Overview

The first phase of Implementation is being referred to as the "MVP Stage", or "Minimum Viable Product". The goal of the MVP phase is to move implementers on to the new PCS FHIR standard with minimal effort by making the majority of new fields optional during this phase. Note: It is expected that many implementers will map between CPHA3 and FHIR during this phase, rather than to natively support FHIR.

Implementers may choose to "send" additional “optional” or “recommended” data (eg compound ingredient fields) if they are able to do so, however there is no expectation that the new fields will be consumed by the receiver during the initial phase, unless this is coordinated/communicated between implementation partners. A complete list of new fields and functionality, along with the MVP scope and sender/receiver responsibilities is included in the pages which follow.

The subsequent implementation phases, beyond MVP will include implementation of the remaining functionality as it applies to that organization’s business. For instance, if pharmacy services are not a part of benefits, they need not be implemented.

All PCS FHIR messages are mandatory for FHIR during the MVP Phase. When an implementer moves to FHIR it is expected that they will move to PCS for all transaction types, rather than support a subset of messages only during MVP. Note: Some of the existing CPHA3 transactions have been deprecated.

Message Identifiers (Event Codes)

FHIR Request Event Code	CPHA Trxn Code	Description	Response
01	01	Claim Request for Dispense transaction with one (1) pay provider claim or pay cardholder claim for a dispense	51
02	NEW - not in CPHA	Professional Services claim request with one (1) pay provider or pay cardholder claim	52
11	11	Reversal of either a dispense or professional services claim	61
30	30	Request for Daily Totals	80
31	31,32,33	Request for Adjudication Details	81