This page is part of the Da Vinci Prior Authorization Support (PAS) FHIR IG (v2.1.0-preview: QA Preview) based on FHIR (HL7® FHIR® Standard) R4. The current version which supersedes this version is 2.0.1. For a full list of available versions, see the Directory of published versions

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: Error Response Example - JSON Representation

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{
  "resourceType" : "ClaimResponse",
  "id" : "ErrorResponseExample",
  "meta" : {
    "profile" : [
      🔗 "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claimresponse"
    ]
  },
  "text" : {
    "status" : "extensions",
    "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p class=\"res-header-id\"><b>Generated Narrative: ClaimResponse ErrorResponseExample</b></p><a name=\"ErrorResponseExample\"> </a><a name=\"hcErrorResponseExample\"> </a><a name=\"ErrorResponseExample-en-US\"> </a><p><b>identifier</b>: <code>http://example.org/PATIENT_EVENT_TRACE_NUMBER</code>/111099</p><p><b>status</b>: Active</p><p><b>type</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/claim-type professional}\">Professional</span></p><p><b>use</b>: Preauthorization</p><p><b>patient</b>: <a href=\"Patient-SubscriberExample.html\">JOE SMITH  Male, DoB Unknown ( http://example.org/MIN#12345678901)</a></p><p><b>created</b>: 2005-05-02 11:02:00+0500</p><p><b>insurer</b>: <a href=\"Organization-InsurerExample.html\">Organization MARYLAND CAPITAL INSURANCE COMPANY</a></p><p><b>requestor</b>: <a href=\"Organization-UMOExample.html\">Organization DR. JOE SMITH CORPORATION</a></p><p><b>request</b>: <a href=\"Claim-ReferralAuthorizationExample.html\">Claim: extension = Urgent; identifier = http://example.org/PATIENT_EVENT_TRACE_NUMBER#111099; status = active; type = Professional; use = preauthorization; created = 2005-05-02 11:01:00+0500; priority = Normal</a></p><p><b>outcome</b>: Error</p><blockquote><p><b>error</b></p><p><b>code</b>: <span title=\"Codes:{https://codesystem.x12.org/005010/901 04}\">04</span></p></blockquote><blockquote><p><b>error</b></p><p><b>ErrorElement</b>: 2010A-NM103</p><p><b>ErrorPath</b>: Bundle.entry[1].Organization.name</p><p><b>ErrorFollowupAction</b>: <span title=\"Codes:{https://codesystem.x12.org/005010/889 C}\">C</span></p><p><b>code</b>: <span title=\"Codes:{https://codesystem.x12.org/005010/901 T4}\">T4</span></p></blockquote></div>"
  },
  "identifier" : [
    {
      "system" : "http://example.org/PATIENT_EVENT_TRACE_NUMBER",
      "value" : "111099",
      "assigner" : {
        "identifier" : {
          "system" : "http://example.org/USER_ASSIGNED",
          "value" : "9012345678"
        }
      }
    }
  ],
  "status" : "active",
  "type" : {
    "coding" : [
      {
        "system" : "http://terminology.hl7.org/CodeSystem/claim-type",
        "code" : "professional"
      }
    ]
  },
  "use" : "preauthorization",
  "patient" : {
    🔗 "reference" : "Patient/SubscriberExample"
  },
  "created" : "2005-05-02T11:02:00+05:00",
  "insurer" : {
    🔗 "reference" : "Organization/InsurerExample"
  },
  "requestor" : {
    🔗 "reference" : "Organization/UMOExample"
  },
  "request" : {
    🔗 "reference" : "Claim/ReferralAuthorizationExample"
  },
  "outcome" : "error",
  "error" : [
    {
      "code" : {
        "coding" : [
          {
            "system" : "https://codesystem.x12.org/005010/901",
            "code" : "04"
          }
        ]
      }
    },
    {
      "extension" : [
        {
          "url" : "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-errorElement",
          "valueString" : "2010A-NM103"
        },
        {
          "url" : "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-errorPath",
          "valueString" : "Bundle.entry[1].Organization.name"
        },
        {
          "url" : "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-errorFollowupAction",
          "valueCodeableConcept" : {
            "coding" : [
              {
                "system" : "https://codesystem.x12.org/005010/889",
                "code" : "C"
              }
            ]
          }
        }
      ],
      "code" : {
        "coding" : [
          {
            "system" : "https://codesystem.x12.org/005010/901",
            "code" : "T4"
          }
        ]
      }
    }
  ]
}