This page is part of the Da Vinci Prior Authorization Support (PAS) FHIR IG (v2.0.1: STU 2) based on FHIR (HL7® FHIR® Standard) R4. This is the current published version. For a full list of available versions, see the Directory of published versions

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: Error Response Example - XML Representation

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<ClaimResponse xmlns="http://hl7.org/fhir">
  <id value="ErrorResponseExample"/>
  <meta>
    <profile
             value="http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claimresponse"/>
  </meta>
  <text>
    <status value="extensions"/>
    <div xmlns="http://www.w3.org/1999/xhtml"><p><b>Generated Narrative: ClaimResponse</b><a name="ErrorResponseExample"> </a></p><div style="display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%"><p style="margin-bottom: 0px">Resource ClaimResponse &quot;ErrorResponseExample&quot; </p><p style="margin-bottom: 0px">Profile: <a href="StructureDefinition-profile-claimresponse.html">PAS Claim Response</a></p></div><p><b>identifier</b>: id: 111099</p><p><b>status</b>: active</p><p><b>type</b>: Professional <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (<a href="http://terminology.hl7.org/5.0.0/CodeSystem-claim-type.html">Claim Type Codes</a>#professional)</span></p><p><b>use</b>: preauthorization</p><p><b>patient</b>: <a href="Patient-SubscriberExample.html">Patient/SubscriberExample</a> &quot; SMITH&quot;</p><p><b>created</b>: 2005-05-02 11:02:00+0500</p><p><b>insurer</b>: <a href="Organization-InsurerExample.html">Organization/InsurerExample</a> &quot;MARYLAND CAPITAL INSURANCE COMPANY&quot;</p><p><b>requestor</b>: <a href="Organization-UMOExample.html">Organization/UMOExample</a> &quot;DR. JOE SMITH CORPORATION&quot;</p><p><b>outcome</b>: error</p><blockquote><p><b>error</b></p><p><b>code</b>: 04 <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (901#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>: C <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (889#C)</span></p><p><b>code</b>: T4 <span style="background: LightGoldenRodYellow; margin: 4px; border: 1px solid khaki"> (901#T4)</span></p></blockquote></div>
  </text>
  <identifier>
    <system value="http://example.org/PATIENT_EVENT_TRACE_NUMBER"/>
    <value value="111099"/>
    <assigner>
      <identifier>
        <system value="http://example.org/USER_ASSIGNED"/>
        <value value="9012345678"/>
      </identifier>
    </assigner>
  </identifier>
  <status value="active"/>
  <type>
    <coding>
      <system value="http://terminology.hl7.org/CodeSystem/claim-type"/>
      <code value="professional"/>
    </coding>
  </type>
  <use value="preauthorization"/>
  <patient>🔗 
    <reference value="Patient/SubscriberExample"/>
  </patient>
  <created value="2005-05-02T11:02:00+05:00"/>
  <insurer>🔗 
    <reference value="Organization/InsurerExample"/>
  </insurer>
  <requestor>🔗 
    <reference value="Organization/UMOExample"/>
  </requestor>
  <outcome value="error"/>
  <error>
    <code>
      <coding>
        <system value="https://codesystem.x12.org/005010/901"/>
        <code value="04"/>
      </coding>
    </code>
  </error>
  <error>
    <extension
               url="http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-errorElement">
      <valueString value="2010A-NM103"/>
    </extension>
    <extension
               url="http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-errorPath">
      <valueString value="Bundle.entry[1].Organization.name"/>
    </extension>
    <extension
               url="http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-errorFollowupAction">
      <valueCodeableConcept>
        <coding>
          <system value="https://codesystem.x12.org/005010/889"/>
          <code value="C"/>
        </coding>
      </valueCodeableConcept>
    </extension>
    <code>
      <coding>
        <system value="https://codesystem.x12.org/005010/901"/>
        <code value="T4"/>
      </coding>
    </code>
  </error>
</ClaimResponse>