<?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>