<status value="draft" /> <description value="Reversal Parameters IN profile" /> <purpose value="Reversal Parameters profile" /> <fhirVersion value="4.0.1" /> <kind value="resource" /> <abstract value="false" /> <type value="Parameters" /> <baseDefinition value="http://hl7.org/fhir/StructureDefinition/Parameters" /> <derivation value="constraint" /> <differential> <element id="Parameters.parameter"> <path value="Parameters.parameter" /> <slicing> <discriminator> <type value="value" /> <path value="name" /> </discriminator> <rules value="open" /> </slicing> <mustSupport value="true" /> </element> <element id="Parameters.parameter:AdjudicationDate"> <path value="Parameters.parameter" /> <sliceName value="AdjudicationDate" /> <comment value="Usage: The date, as determined by the processor, on which the claim, transaction or request being responded to has been adjudicated. This date is found in the ClaimResponse.created data element. This must be present when reversal a claim that has been adjudicated. CPHA Map: D.77.03 Adjudication Date" /> <mustSupport value="true" /> </element> <element id="Parameters.parameter:AdjudicationDate.name"> <path value="Parameters.parameter.name" /> <fixedString value="AdjudicationDate" /> <mustSupport value="true" /> </element> <element id="Parameters.parameter:AdjudicationDate.value[x]"> <path value="Parameters.parameter.value[x]" /> <min value="1" /> <type> <code value="dateTime" /> </type> <mustSupport value="true" /> </element> <element id="Parameters.parameter:TraceNumber"> <path value="Parameters.parameter" /> <sliceName value="TraceNumber" /> <comment value="Usage Note: Trace number from the claim which is echoed back in the response CPHA map: E.02.03 Trace Number." /> <min value="1" /> <max value="1" /> <mustSupport value="true" /> </element> <element id="Parameters.parameter:TraceNumber.name"> <path value="Parameters.parameter.name" /> <fixedString value="TraceNumber" /> <mustSupport value="true" /> </element> <element id="Parameters.parameter:TraceNumber.value[x]"> <path value="Parameters.parameter.value[x]" /> <type> <code value="Identifier" /> </type> <mustSupport value="true" /> </element> <element id="Parameters.parameter:TraceNumber.value[x].system"> <path value="Parameters.parameter.value[x].system" /> <mustSupport value="true" /> </element> <element id="Parameters.parameter:TraceNumber.value[x].value"> <path value="Parameters.parameter.value[x].value" /> <min value="1" /> <mustSupport value="true" /> </element> <element id="Parameters.parameter:ReferenceNumber"> <path value="Parameters.parameter" /> <sliceName value="ReferenceNumber" /> <comment value="Usage Note: This is an internal reference number assigned to each claim by the processor. This is optional as Pharmacies may reverse a claim when no adjudication response has been received. CPHA map: E.04. 03 Reference Number" /> <mustSupport value="true" /> </element> <element id="Parameters.parameter:ReferenceNumber.name"> <path value="Parameters.parameter.name" /> <fixedString value="ReferenceNumber" /> <mustSupport value="true" /> </element> <element id="Parameters.parameter:ReferenceNumber.value[x]"> <path value="Parameters.parameter.value[x]" /> <comment value="Usage Note: The system should be included when known." /> <type> <code value="Identifier" /> </type> <mustSupport value="true" /> </element> <element id="Parameters.parameter:ReferenceNumber.value[x].system"> <path value="Parameters.parameter.value[x].system" /> <mustSupport value="true" /> </element> <element id="Parameters.parameter:ReferenceNumber.value[x].value"> <path value="Parameters.parameter.value[x].value" /> <min value="1" /> <mustSupport value="true" /> </element> <element id="Parameters.parameter:CurrentRXNumber"> <path value="Parameters.parameter" /> <sliceName value="CurrentRXNumber" /> <comment value="Usage Note: This is the current prescription number of the claim that is to be reversed. In FHIR this is found in the MedicationDispense.identifier CPHA Map: D.55.03" /> <min value="1" /> <max value="1" /> <mustSupport value="true" /> </element> <element id="Parameters.parameter:CurrentRXNumber.name"> <path value="Parameters.parameter.name" /> <fixedString value="CurrentRXNumber" /> <mustSupport value="true" /> </element> <element id="Parameters.parameter:CurrentRXNumber.value[x]"> <path value="Parameters.parameter.value[x]" /> <comment value="Usage Note: In FHIR, the system is known and must be present when known. It is optional for backward compatibility to CPHA3." /> <type> <code value="Identifier" /> </type> </element> <element id="Parameters.parameter:CurrentRXNumber.value[x].system"> <path value="Parameters.parameter.value[x].system" /> <mustSupport value="true" /> </element> <element id="Parameters.parameter:CurrentRXNumber.value[x].value"> <path value="Parameters.parameter.value[x].value" /> <min value="1" /> <mustSupport value="true" /> </element> <element id="Parameters.parameter:ProviderTransactionDate"> <path value="Parameters.parameter" /> <sliceName value="ProviderTransactionDate" /> <comment value="Usage Note: This is the date of the claim request as assigned by the provider. This must be present" /> <min value="1" /> <max value="1" /> <mustSupport value="true" /> </element> <element id="Parameters.parameter:ProviderTransactionDate.name"> <path value="Parameters.parameter.name" /> <fixedString value="ProviderTransactionDate" /> <mustSupport value="true" /> </element> <element id="Parameters.parameter:ProviderTransactionDate.value[x]"> <path value="Parameters.parameter.value[x]" /> <comment value="Usage Note: This is an internal reference number assigned to each claim by the processor. This date is from the Claim.created field in the claim request CPHA Map: B.22.03 Provider Transaction Date" /> <min value="1" /> <type> <code value="dateTime" /> </type> <mustSupport value="true" /> </element> </differential> </StructureDefinition>