51-Claim Response - Dispense

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Bundle.entry[1].resource[0].request[0].display[0]TraceNumber B.23.03
Bundle.entry[1].resource[0].outcome[0]complete
Bundle.entry[1].resource[0].disposition[0]A
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Bundle.entry[1].resource[0].preAuthPeriod[0].end[0]2025-12-31
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Bundle.entry[1].resource[0].item[0].adjudication[1].category[0].coding[0].code[0]Upcharge
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Bundle.entry[1].resource[0].item[0].adjudication[13].category[0].coding[0].code[0]ResponseCode
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Bundle.entry[1].resource[0].item[0].adjudication[13].reason[0].coding[0].code[0]DH
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Bundle.entry[1].resource[0].processNote[0].extension[0].url[0]http://pharmacyeclaims.ca/FHIR/v1.0/StructureDefinition/ext-ProcessNoteDirectedTo
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Bundle.entry[1].resource[0].processNote[0].number[0]1
Bundle.entry[1].resource[0].processNote[0].type[0]display
Bundle.entry[1].resource[0].processNote[0].text[0]Please verify diagnosis coding for future claims.
Bundle.entry[1].resource[0].processNote[0].language[0].coding[0].system[0]urn:ietf:bcp:47
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]
},
"value": 87
},
{
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{
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}
]
},
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{
"system": "http://pharmacyeclaims.ca/FHIR/CodeSystem/FHIR-response-codes",
"code": "DJ"
}
]
}
},
{
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{
"code": "ResponseCode"
}
]
},
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{
"system": "http://pharmacyeclaims.ca/FHIR/CodeSystem/FHIR-response-codes",
"code": "DH"
}
]
}
}
]
}
],
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{
"system": "http://terminology.hl7.org/CodeSystem/ex-paymenttype",
"code": "complete"
}
]
},
"amount": {
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}
},
"processNote": [
{
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{
"url": "http://pharmacyeclaims.ca/FHIR/v1.0/StructureDefinition/ext-ProcessNoteDirectedTo",
"valueCode": "provider"
}
],
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"type": "display",
"text": "Please verify diagnosis coding for future claims.",
"language": {
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{
"system": "urn:ietf:bcp:47",
"code": "en"
}
]
}
}
]
}
},
{
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{
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},
"system": "POSSystemIDTBD",
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},
{
"type": {
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{
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},
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],
"name": [
{
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]
}
],
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"birthDate": "2018-06-23"
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},
{
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"identifier": [
{
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"value": "InsurerID"
}
],
"name": "BestInsurerEver"
}
}
]
}