Eligibilityresponse-example-error.xml

General Person Primary Coverage with error (id = "E2503")

<EligibilityResponse xmlns="http://hl7.org/fhir">
  <id value="E2503"/> 

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

  <identifier> 
    <system value="http://www.BenefitsInc.com/fhir/eligibilityresponse"/> 
    <value value="8812343"/> 
  </identifier> 

  <status value="active"/> 

  <created value="2014-09-16"/> 

  <requestProvider> 
    <identifier> 
      <system value="http://national.org/provider"/> 
      <value value="PR9876"/> 
    </identifier>   
  </requestProvider> 

  <requestOrganization>  
    <identifier> 
      <system value="http://national.org/clinic"/> 
      <value value="OR1234"/> 
    </identifier>    
  </requestOrganization> 

  <request> 
    <reference value="http://www.BenefitsInc.com/fhir/eligibility/225476332406"/> 
  </request> 

  <outcome> 
    <coding> 
      <system value="http://hl7.org/fhir/remittance-outcome"/> 
      <code value="error"/> 
    </coding> 
  </outcome> 

  <disposition value="Eligibiliy request could not be processed, please address errors before submitting."/> 

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

  <form> 
    <coding> 
      <system value="http://national.org/form"/> 
      <code value="ELRSP/2017/01"/> 
    </coding> 
  </form> 

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

</EligibilityResponse>