Da Vinci Prior Authorization Support (PAS) FHIR IG
1.2.0-ballot - STU 1.2 US

This page is part of the Da Vinci Prior Authorization Support (PAS) FHIR IG (v1.2.0-ballot: STU 1.2 Ballot 1) based on FHIR R4. The current version which supercedes this version is 1.1.0. For a full list of available versions, see the Directory of published versions

Example ClaimResponse: Error Response Example

Generated Narrative

Resource "ErrorResponseExample"

Profile: PAS Claim Response

identifier: id: 111099

status: active

type: Professional (Claim Type Codes#professional)

use: preauthorization

patient: Patient/SubscriberExample " SMITH"

created: 2005-05-02 11:02:00+0500

insurer: Organization/InsurerExample "MARYLAND CAPITAL INSURANCE COMPANY"

requestor: Organization/UMOExample "DR. JOE SMITH CORPORATION"

outcome: error

error

code: 04 (X12 278 Reject Reason Code System#04)

error

ErrorElement: 2010A-NM103

ErrorFollowupAction: C (X12 278 Follow Up Action Code System#C)

code: T4 (X12 278 Reject Reason Code System#T4)