Processresponse-example-error.xml

Sample ProcessResponse with error (id = "SR2349")

<?xml version="1.0" encoding="UTF-8"?>

<ProcessResponse xmlns="http://hl7.org/fhir">
  <id value="SR2349"/> 

  <text> 
    <status value="generated"/> 
    <div xmlns="http://www.w3.org/1999/xhtml">A human-readable rendering of the ProcessResponse</div> 
  </text> 

  <identifier> 
    <system value="http://www.BenefitsInc.com/fhir/processresponse"/> 
    <value value="ER987634"/> 
  </identifier> 

  <status value="active"/> 

  <created value="2014-07-14"/> 

  <organization> 
    <reference value="Organization/2"/> 
  </organization> 

  <request> 
    <reference value="http://happyvalley.com/fhir/claim/12204"/> 
  </request> 

  <outcome value="error"/> 

  <disposition value="Referred to claim not found on system."/> 

  <requestProvider> 
    <identifier> 
      <system value="http://npid.org/providerid"/> 
      <value value="AZ43258"/> 
    </identifier> 
  </requestProvider> 

  <form> 
    <coding> 
      <system value="http://ncforms.org/formid"/> 
      <code value="PRRESP/2016/01"/> 
    </coding> 
  </form> 

  <processNote> 
    <type value="print"/> 
    <text value="Please check the submitted payor identification and local claim number."/> 
  </processNote> 

  <error> 
    <coding> 
      <system value="http://terminology.hl7.org/CodeSystem/adjudication-error"/> 
      <code value="a001"/> 
    </coding> 
  </error> 

</ProcessResponse>