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

      <id value="E2503"/>

      <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://www.BenefitsInc.com/fhir/coverageeligibilityresponse"/>
              <value value="8812343"/>
      </identifier>

      <status value="active"/>

      <purpose value="validation"/>

      <patient>
              <reference value="Patient/f201"/>
      </patient>

      <created value="2014-09-16"/>

      <requestor>
              <identifier>
                      <system value="http://national.org/clinic"/>
                      <value value="OR1234"/>
              </identifier>   
      </requestor>

      <request>
              <reference value="http://www.BenefitsInc.com/fhir/CoverageEligibilityRequest/225476332406"/>
      </request>

      <outcome value="error"/>

      <disposition value="Eligibiliy request could not be processed, please address errors before submitting."/>

      <insurer>
              <reference value="Organization/2"/>
      </insurer>

      <form>
              <coding>
                      <system value="http://national.org/form"/>
                      <code value="ELRSP/2017/01"/>
              </coding>
      </form>

      <error>
              <code>
                      <coding>
                              <system value="http://terminology.hl7.org/CodeSystem/adjudication-error"/>
                              <code value="a001"/>
                      </coding>
              </code>
      </error>

</CoverageEligibilityResponse>