R6 Ballot (2nd Draft)

Publish-box (todo)

Example ClaimResponse/R3501 (JSON)

Financial Management Work GroupMaturity Level: N/AStandards Status: InformativeCompartments: Patient, Practitioner

Raw JSON (canonical form + also see JSON Format Specification)

A ClaimResponse for a Claim that contains processing errors

{
  "resourceType" : "ClaimResponse",
  "id" : "R3501",
  "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" : {
      "coding" : [{
        "system" : "http://hl7.org/fhir/note-type",
        "code" : "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"
      }]
    }
  }]
}

Usage note: every effort has been made to ensure that the examples are correct and useful, but they are not a normative part of the specification.