Claim Response - Errors

A Claim Response is returned when the processor (eg adjudicator) returns a FHIR bundle that is successfully parsed and processed, with errors. The errors will prevent the claim from being fully adjudicated.

PCS FHIR Approach

In CPHA 3, errors are returned using the same adjudicated response message with the Response Codes to convey the error. This approach was reviewed by the Techical Working Group and a decision was made to continue using response codes for the initial implementation phase (MVP). There is not the time or committment to split the adjudicated response codes from the error codes. The benefit was deemed to be minor compared with the extra effort.

The prefered way to address this in FHIR would be to use the designated error field, which allows the sending application to easily distinguish between a true error (an issue to be corrected/re-submitted) and other response codes. If in future this may be re-visited.

Please refer to the Error Code page for further details.