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Resource "R3501" Version "1" (ClaimResponse)

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XML or JSON representation . provenance for this resource

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

{
  "resourceType" : "ClaimResponse",
  "id" : "R3501",
  "meta" : {
    "versionId" : "1",
    "lastUpdated" : "2018-12-14T02:01:34.192Z"
  },
  "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" : "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"
          }
        ]
      }
    }
  ]
}