<?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>