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See the Directory of published versions
A ClaimResponse for a Claim that contains processing errors
{
"resourceType" : "ClaimResponse",
"id" : "R3501",
"text" : {
"status" : "generated",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\">A human-readable rendering of the ClaimResponse that demonstrates returning errors</div>"
},
"identifier" : [{
"system" : "http://www.BenefitsInc.com/fhir/remittance",
"value" : "R3501"
}],
"status" : "active",
"type" : {
"coding" : [{
"system" : "http://terminology.hl7.org/CodeSystem/claim-type",
"code" : "oral"
}]
},
"use" : "claim",
"patient" : {
"reference" : "Patient/1"
},
"created" : "2014-08-16",
"insurer" : {
"identifier" : {
"system" : "http://www.jurisdiction.org/insurers",
"value" : "555123"
}
},
"requestor" : {
"reference" : "Practitioner/1"
},
"request" : {
"reference" : "Claim/100156"
},
"outcome" : "error",
"disposition" : "Claim could not be processed",
"formCode" : {
"coding" : [{
"system" : "http://terminology.hl7.org/CodeSystem/forms-codes",
"code" : "2"
}]
},
"processNote" : [{
"number" : 1,
"type" : {
"coding" : [{
"system" : "http://hl7.org/fhir/note-type",
"code" : "display"
}]
},
"text" : "Invalid claim",
"language" : {
"coding" : [{
"system" : "urn:ietf:bcp:47",
"code" : "en-CA"
}]
}
}],
"communicationRequest" : [{
"reference" : "CommunicationRequest/fm-solicit"
}],
"error" : [{
"itemSequence" : 3,
"detailSequence" : 2,
"code" : {
"coding" : [{
"system" : "http://terminology.hl7.org/CodeSystem/adjudication-error",
"code" : "a002"
}]
}
}]
}
Usage note: every effort has been made to ensure that the
examples are correct and useful, but they are not a normative part
of the specification.