{

"resourceType": "CoverageEligibilityResponse",
"id": "E2503",
"identifier": [
  {
    "system": "http://www.BenefitsInc.com/fhir/coverageeligibilityresponse",
    "value": "8812343"
  }
],
"status": "active",
"purpose": [
  "validation"
],
"patient": {
  "reference": "Patient/f201"
},
"created": "2014-09-16",
"requestor": {
  "identifier": {
    "system": "http://national.org/clinic",
    "value": "OR1234"
  }
},
"request": {
  "reference": "http://www.BenefitsInc.com/fhir/CoverageEligibilityRequest/225476332406"
},
"outcome": "error",
"disposition": "Eligibiliy request could not be processed, please address errors before submitting.",
"insurer": {
  "reference": "Organization/2"
},
"form": {
  "coding": [
    {
      "system": "http://national.org/form",
      "code": "ELRSP/2017/01"
    }
  ]
},
"error": [
  {
    "code": {
      "coding": [
        {
          "system": "http://terminology.hl7.org/CodeSystem/adjudication-error",
          "code": "a001"
        }
      ]
    }
  }
],
"meta": {
  "tag": [
    {
      "system": "http://terminology.hl7.org/CodeSystem/v3-ActReason",
      "code": "HTEST",
      "display": "test health data"
    }
  ]
}

}