# Error Response Example - Da Vinci Prior Authorization Support (PAS) FHIR IG v2.2.0-ballot

## Example ClaimResponse: Error Response Example

Language: en

Profile: [PAS Claim Response](StructureDefinition-profile-claimresponse.md)

**identifier**: `http://example.org/PATIENT_EVENT_TRACE_NUMBER`/111099

**status**: Active

**type**: Professional

**use**: Preauthorization

**patient**: [JOE SMITH Male, DoB Unknown ( Member Number)](Patient-SubscriberExample.md)

**created**: 2005-05-02 11:02:00+0500

**insurer**: [Organization MARYLAND CAPITAL INSURANCE COMPANY](Organization-InsurerExample.md)

**requestor**: [Organization DR. JOE SMITH CORPORATION](Organization-UMOExample.md)

**request**: [Claim: extension = Urgent; identifier = urn:trnorg:9012345678#111099; status = active; type = Professional; use = preauthorization; created = 2005-05-02 11:01:00+0500; priority = Normal](Claim-ReferralAuthorizationExample.md)

**outcome**: Error

> **error****code**: 04

> **error**
> **ErrorElement**
* error: 2010A-NM103

**ErrorPath**: Bundle.entry[1].Organization.name**ErrorFollowupAction**: C**code**: T4



## Resource Content

```json
{
  "resourceType" : "ClaimResponse",
  "id" : "ErrorResponseExample",
  "meta" : {
    "profile" : [
      "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claimresponse"
    ]
  },
  "language" : "en",
  "identifier" : [
    {
      "system" : "http://example.org/PATIENT_EVENT_TRACE_NUMBER",
      "value" : "111099",
      "assigner" : {
        "identifier" : {
          "system" : "http://example.org/USER_ASSIGNED",
          "value" : "9012345678"
        }
      }
    }
  ],
  "status" : "active",
  "type" : {
    "coding" : [
      {
        "system" : "http://terminology.hl7.org/CodeSystem/claim-type",
        "code" : "professional"
      }
    ]
  },
  "use" : "preauthorization",
  "patient" : {
    "reference" : "Patient/SubscriberExample"
  },
  "created" : "2005-05-02T11:02:00+05:00",
  "insurer" : {
    "reference" : "Organization/InsurerExample"
  },
  "requestor" : {
    "reference" : "Organization/UMOExample"
  },
  "request" : {
    "reference" : "Claim/ReferralAuthorizationExample"
  },
  "outcome" : "error",
  "error" : [
    {
      "code" : {
        "coding" : [
          {
            "system" : "https://codesystem.x12.org/005010/901",
            "code" : "04"
          }
        ]
      }
    },
    {
      "extension" : [
        {
          "extension" : [
            {
              "url" : "error",
              "valueString" : "2010A-NM103"
            }
          ],
          "url" : "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-errorElement"
        },
        {
          "url" : "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-errorPath",
          "valueString" : "Bundle.entry[1].Organization.name"
        },
        {
          "url" : "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-errorFollowupAction",
          "valueCodeableConcept" : {
            "coding" : [
              {
                "system" : "https://codesystem.x12.org/005010/889",
                "code" : "C"
              }
            ]
          }
        }
      ],
      "code" : {
        "coding" : [
          {
            "system" : "https://codesystem.x12.org/005010/901",
            "code" : "T4"
          }
        ]
      }
    }
  ]
}

```
