ClaimResponse Example: claimresponse-example-2

Narrative

A human-readable rendering of the ClaimResponse that demonstrates returning errors

Example XML

<ClaimResponse xmlns="http://hl7.org/fhir" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance"
    xsi:schemaLocation="http://hl7.org/fhir ../../schema/claimresponse.xsd">

    <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>

    <!-- Detailed error description -->
    <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>