Claim PaymentNotice Example (id = "77654")

<?xml version="1.0" encoding="UTF-8"?>

<PaymentNotice xmlns="http://hl7.org/fhir">
  <id value="77654"/> 

  <text> 
    <status value="generated"/> 
    <div xmlns="http://www.w3.org/1999/xhtml">A human-readable rendering of the PaymentNotice</div> 
  </text> 

  <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"/> 

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

  <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>