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  "resourceType": "ClaimResponse",

  "communicationRequest": [

    {
      "reference": "CommunicationRequest/1"

    }
  ],
  "error": [

    {
      "code":

 {
        "coding":

 [
          {
            "code": "1"

          }
        ]
      }
    }
  ],
  "id": "code",

  "identifier": [

    {
      "type":

 {
        "coding":

 [
          {
            "code": "ACSN",

            "system": "https://hl7.org/fhir/valueset-identifier-type.html"

          }
        ]
      },
      "use": "usual",

      "value": 1

    },

    {
      "type":

 {
        "coding":

 [
          {
            "code": "MR",

            "system": "https://hl7.org/fhir/valueset-identifier-type.html"

          }
        ]
      },
      "use": "usual",

      "value": "code"

    }
  ],
  "item": [

    {
      "adjudication":

 [
        {
          "amount":

 {
            "value":

 2
          },
          "category":

 {
            "text": "general"

          },
          "reason":

 {
            "coding":

 [
              {
                "code": "1",

                "system": "passed"

              }
            ]
          },
          "value":

 4
        },
        {
          "category":

 {
            "text": "rejected_reason"

          },
          "reason":

 {
            "coding":

 [
              {
                "code": "1"

              }
            ]
          }
        }
      ],
      "noteNumber":

 [
        1
      ],
      "sequenceLinkId": 1

    },

    {
      "adjudication":

 [
        {
          "amount":

 {
            "value":

 4
          },
          "category":

 {
            "text": "general"

          },
          "reason":

 {
            "coding":

 [
              {
                "code": "2",

                "system": "rejected"

              }
            ]
          },
          "value":

 3
        },
        {
          "category":

 {
            "text": "rejected_reason"

          },
          "reason":

 {
            "coding":

 [
              {
                "code": "3"

              }
            ]
          }
        }
      ],
      "noteNumber":

 [
        2
      ],
      "sequenceLinkId": 2

    }
  ],
  "outcome": {

    "coding":

 [
      {
        "code": "1"

      }
    ],
    "text": "rejected"

  },

  "payment": {

    "adjustmentReason":

 {
      "text": "adjustment"

    },

    "date": "2010-11-16T00:00:00"

  },

  "processNote": [

    {
      "number": 1,

      "text": "item justification"

    },

    {
      "number": 2,

      "text": "service justification"

    }
  ],
  "totalBenefit": {

    "value": 214.25

  }

}