<?xml version=“1.0” encoding=“UTF-8”?> <PaymentNotice xmlns=“hl7.org/fhir”>

      <id value="77654"/>

      <meta>
  <security>
    <system value="http://terminology.hl7.org/CodeSystem/v3-ActReason"/>
    <code value="HTEST"/>
    <display value="test health data"/>
  </security>
</meta>

      <identifier>
              <system value="http://benefitsinc.com/paymentnotice"/>
              <value value="776543"/>
      </identifier>

      <status value="active"/>

      <request>
              <reference value="http://benefitsinc.com/fhir/claim/12345"/>
      </request>

      <response>
              <reference value="http://benefitsinc.com/fhir/claimresponse/CR12345"/>
      </response>

      <created value="2014-08-16"/>

      <provider>
              <reference value="Organization/1"/>
      </provider>

      <payment>
              <reference value="PaymentReconciliation/ER2500"/>
      </payment>

      <paymentDate value="2014-08-15"/>

      <payee>
              <reference value="Organization/1"/>
      </payee>

      <recipient>
              <identifier>
                      <system value="http://regulators.gov"/>
                      <value value="AB123"/>
              </identifier>
      </recipient>

      <amount>
              <value value="12500.00"/>
              <currency value="USD"/> 
      </amount>

      <paymentStatus>
              <coding>
                      <system value="http://terminology.hl7.org/CodeSystem/paymentstatus"/>
                      <code value="paid"/>
              </coding>
      </paymentStatus>

</PaymentNotice>