<ClaimResponse xmlns="http://hl7.org/fhir"><id value="R3501"/><text><status value="generated"/><div xmlns="http://www.w3.org/1999/xhtml">A human-readable rendering of the ClaimResponse that demonstrates returning errors</div></text><identifier><system value="http://www.BenefitsInc.com/fhir/remittance"/><value value="R3501"/></identifier><status value="active"/><type><coding><system value="http://terminology.hl7.org/CodeSystem/claim-type"/><code value="oral"/></coding></type><use value="claim"/><subject><reference value="Patient/1"/></subject><created value="2014-08-16"/><insurer><identifier><system value="http://www.jurisdiction.org/insurers"/><value value="555123"/></identifier></insurer><requestor><reference value="Practitioner/1"/></requestor><request><reference value="Claim/100156"/></request><outcome value="error"/><disposition value="Claim could not be processed"/><formCode><coding><system value="http://terminology.hl7.org/CodeSystem/forms-codes"/><code value="2"/></coding></formCode><processNote><number value="1"/><type><coding><system value="http://hl7.org/fhir/note-type"/><code value="display"/></coding></type><text value="Invalid claim"/><language><coding><system value="urn:ietf:bcp:47"/><code value="en-CA"/></coding></language></processNote><communicationRequest><reference value="CommunicationRequest/fm-solicit"/></communicationRequest><error><itemSequence value="3"/><detailSequence value="2"/><code><coding><system value="http://terminology.hl7.org/CodeSystem/adjudication-error"/><code value="a002"/></coding></code></error></ClaimResponse>