This page is part of the Da Vinci Prior Authorization Support (PAS) FHIR IG (v2.1.0: 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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: Rejection Response Example - XML Representation

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<ClaimResponse xmlns="http://hl7.org/fhir">
  <id value="RejectionResponseExample"/>
  <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 class="res-header-id"><b>Generated Narrative: ClaimResponse RejectionResponseExample</b></p><a name="RejectionResponseExample"> </a><a name="hcRejectionResponseExample"> </a><a name="RejectionResponseExample-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 ( Member Number)</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-HomecareAuthorizationUpdateExample.html">Claim: identifier = http://example.org/PATIENT_EVENT_TRACE_NUMBER#111099-UPDATE; status = active; type = Professional; use = preauthorization; created = 2019-07-20 11:01:00+0500; priority = Normal</a></p><p><b>outcome</b>: Error</p><h3>ProcessNotes</h3><table class="grid"><tr><td style="display: none">-</td><td><b>Number</b></td><td><b>Text</b></td></tr><tr><td style="display: none">*</td><td>1</td><td>Updates are not allowed. A new auth request must be submitted.</td></tr></table><blockquote><p><b>error</b></p><p><b>ErrorElement</b>: 2000E</p><p><b>ErrorFollowupAction</b>: <span title="Codes:{https://codesystem.x12.org/005010/889 N}">N</span></p><p><b>code</b>: <span title="Codes:{https://codesystem.x12.org/005010/901 33}">33</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>
  <request>🔗 
    <reference value="Claim/HomecareAuthorizationUpdateExample"/>
  </request>
  <outcome value="error"/>
  <processNote>
    <number value="1"/>
    <text
          value="Updates are not allowed. A new auth request must be submitted."/>
  </processNote>
  <error>
    <extension
               url="http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-errorElement">
      <valueString value="2000E"/>
    </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="N"/>
        </coding>
      </valueCodeableConcept>
    </extension>
    <code>
      <coding>
        <system value="https://codesystem.x12.org/005010/901"/>
        <code value="33"/>
      </coding>
    </code>
  </error>
</ClaimResponse>