Coverageeligibilityresponse-example-error.xml

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

<?xml version="1.0" encoding="UTF-8"?>

<CoverageEligibilityResponse 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 CoverageEligibilityResponse.</div> 
  </text> 

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

  <status value="active"/> 

  <purpose value="validation"/> 

  <patient> 
    <reference value="Patient/f201"/> 
  </patient> 

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

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

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

  <outcome value="error"/> 
  
  <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://terminology.hl7.org/CodeSystem/adjudication-error"/> 
        <code value="a001"/> 
      </coding> 
    </code> 
  </error> 

</CoverageEligibilityResponse>