{

"resourceType": "ProcessResponse",
"id": "SR2349",
"text": {
  "status": "generated",
  "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">A human-readable rendering of the ProcessResponse</div>"
},
"identifier": [
  {
    "system": "http://www.BenefitsInc.com/fhir/processresponse",
    "value": "ER987634"
  }
],
"status": "active",
"created": "2014-07-14",
"organization": {
  "reference": "Organization/2"
},
"request": {
  "reference": "http://happyvalley.com/fhir/claim/12204"
},
"outcome": {
  "coding": [
    {
      "system": "http://hl7.org/fhir/processoutcomecodes",
      "code": "error"
    }
  ]
},
"disposition": "Referred to claim not found on system.",
"requestProvider": {
  "identifier": {
    "system": "http://npid.org/providerid",
    "value": "AZ43258"
  }
},
"requestOrganization": {
  "reference": "Organization/1"
},
"form": {
  "coding": [
    {
      "system": "http://ncforms.org/formid",
      "code": "PRRESP/2016/01"
    }
  ]
},
"processNote": [
  {
    "type": {
      "coding": [
        {
          "system": "http://hl7.org/fhir/note-type",
          "code": "print"
        }
      ]
    },
    "text": "Please check the submitted payor identification and local claim number."
  }
],
"error": [
  {
    "coding": [
      {
        "system": "http://hl7.org/fhir/adjudication-error",
        "code": "a001"
      }
    ]
  }
]

}