<?xml version=“1.0” encoding=“UTF-8”?><PaymentReconciliation xmlns=“hl7.org/fhir”>
<id value="ER2500"/> <text> <status value="generated"/> <div xmlns="http://www.w3.org/1999/xhtml">A human-readable rendering of the PaymentReconciliation</div> </text> <identifier> <system value="http://www.BenefitsInc.com/fhir/enrollmentresponse"/> <value value="781234"/> </identifier> <request> <reference value="http://www.BenefitsInc.com/fhir/eligibility/225476332402"/> </request> <outcome value="complete"/> <disposition value="2014 August mid-month settlement."/> <created value="2014-08-16"/> <organization> <reference value="Organization/2"/> </organization> <requestOrganization> <reference value="Organization/1"/> </requestOrganization> <detail> <type> <system value="http://hl7.org/fhir/paymenttype"/> <code value="payment"/> </type> <request> <reference value="http://www.BenefitsInc.com/fhir/oralhealthclaim/225476332402"/> </request> <date value="2014-08-16"/> <amount> <value value="1000.00"/> <system value="urn:iso:std:iso:4217"/> <code value="USD"/> </amount> </detail> <detail> <type> <system value="http://hl7.org/fhir/paymenttype"/> <code value="payment"/> </type> <request> <reference value="http://www.BenefitsInc.com/fhir/oralhealthclaim/225476332699"/> </request> <date value="2014-08-12"/> <amount> <value value="4000.00"/> <system value="urn:iso:std:iso:4217"/> <code value="USD"/> </amount> </detail> <detail> <type> <system value="http://hl7.org/fhir/paymenttype"/> <code value="advance"/> </type> <date value="2014-08-16"/> <amount> <value value="-1500.00"/> <system value="urn:iso:std:iso:4217"/> <code value="USD"/> </amount> </detail> <total> <value value="3500.00"/> <system value="urn:iso:std:iso:4217"/> <code value="USD"/> </total>
</PaymentReconciliation>