---
type: "example"
title: "ClaimResponse Example: claimresponse-example-2"
resource: "ClaimResponse"
example: "claimresponse-example-2"
---
# ClaimResponse Example: claimresponse-example-2

## Narrative

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

## Example XML



```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>
```