Claim Response - Errors - TWG review

A Claim Response is returned when the processor (eg adjudicator)the FHIR bundle is successfully parsed and processed but when errors are found which prevents the claim from being fully adjudicatted.

FHIR Approach

In CPHA 3, errors are returned using the same adjudicated response message with the Response Codes to convey the error. While not ideal, this was reviewed by the Techical Working Group and a decision was made to continue using this approach with FHIR. There is not the time or committment to revamp this aspect of the messaging standard to split the adjudicated response codes from the error codes. The benefit is minor compared with the extra effort.

The proper way to address this in FHIR, would be to use the designated error field but this would require effort separate errors response codes from other adjudication results. By not using the designated field for errors, we are not fully conformant to the FHIR standard, which is understood and accepted.