<?xml version="1.0" encoding="UTF-8"?><ExplanationOfBenefit xmlns="http://hl7.org/fhir">
  <id value="EB3501"/>
  <meta>
    <security>
      <system value="http://terminology.hl7.org/CodeSystem/v3-ActReason"/>
      <code value="HTEST"/>
      <display value="test health data"/>
    </security>
  </meta>
  <text>
    <status value="generated"/><div xmlns="http://www.w3.org/1999/xhtml">A human-readable rendering of the ExplanationOfBenefit for a claim that had errors, various other attributes (such as accident and hospitalization) are also completed.</div>
  </text>
  <identifier>
    <system value="http://www.BenefitsInc.com/fhir/explanationofbenefit"/>
    <value value="error-1"/>
  </identifier>
  <status value="active"/>
  <type>
    <coding>
      <system value="http://terminology.hl7.org/CodeSystem/claim-type"/>
      <code value="oral"/>
    </coding>
  </type>
  <subType>
    <coding>
      <system value="http://terminology.hl7.org/CodeSystem/ex-claimsubtype"/>
      <code value="emergency"/>
    </coding>
  </subType>
  <use value="claim"/>
  <subject>
    <reference value="Patient/pat1"/>
  </subject>
  <billablePeriod>
    <start value="2014-02-01"/>
    <end value="2014-03-01"/>
  </billablePeriod>
  <created value="2014-08-16"/>
  <enterer>
    <reference value="Practitioner/1"/>
  </enterer>
  <insurer>
    <reference value="Organization/2"/>
  </insurer>
  <provider>
    <reference value="Organization/2"/>
  </provider>
  <related>
    <reference>
      <system value="http://www.BenefitsInc.com/case-number"/>
      <value value="23-56Tu-XX-47-20150M14"/>
    </reference>
  </related>
  <prescription>
    <reference value="MedicationRequest/medrx002"/>
  </prescription>
  <originalPrescription>
    <reference value="MedicationRequest/medrx0301"/>
  </originalPrescription>
  <facility>
    <reference value="Location/1"/>
  </facility>
  <claim>
    <reference value="Claim/100150"/>
  </claim>
  <claimResponse>
    <reference value="ClaimResponse/R3500"/>
  </claimResponse>
  <outcome value="error"/>
  <disposition value="Could not process."/>
  <supportingInfo>
    <sequence value="1"/>
    <category>
      <coding>
        <system value="http://terminology.hl7.org/CodeSystem/claiminformationcategory"/>
        <code value="employmentimpacted"/>
      </coding>
    </category>
    <timingPeriod>
      <start value="2014-02-14"/>
      <end value="2014-02-28"/>
    </timingPeriod>
  </supportingInfo>
  <supportingInfo>
    <sequence value="2"/>
    <category>
      <coding>
        <system value="http://terminology.hl7.org/CodeSystem/claiminformationcategory"/>
        <code value="hospitalized"/>
      </coding>
    </category>
    <timingPeriod>
      <start value="2014-02-14"/>
      <end value="2014-02-16"/>
    </timingPeriod>
  </supportingInfo>
  <procedure>
    <sequence value="1"/>
    <date value="2014-02-14"/>
    <procedureCodeableConcept>
      <coding>
        <system value="http://hl7.org/fhir/sid/ex-icd-10-procedures"/>
        <code value="123001"/>
      </coding>
    </procedureCodeableConcept>
    <udi>
      <reference value="Device/example"/>
    </udi>
  </procedure>
  <precedence value="2"/>
  <insurance>
    <focal value="true"/>
    <coverage>
      <reference value="Coverage/9876B1"/>
    </coverage>
  </insurance>
  <accident>
    <date value="2014-02-14"/>
    <type>
      <coding>
        <system value="http://terminology.hl7.org/CodeSystem/v3-ActCode"/>
        <code value="SPT"/>
      </coding>
    </type>
    <locationReference>
      <reference value="Location/ph"/>
    </locationReference>
  </accident>
  <total>
    <category>
      <coding>
        <code value="submitted"/>
      </coding>
    </category>
    <amount>
      <value value="2478.57"/>
      <currency value="USD"/>
    </amount>
  </total>
  <total>
    <category>
      <coding>
        <code value="benefit"/>
      </coding>
    </category>
    <amount>
      <value value="0.00"/>
      <currency value="USD"/>
    </amount>
  </total>
  <formCode>
    <coding>
      <system value="http://terminology.hl7.org/CodeSystem/forms-codes"/>
      <code value="2"/>
    </coding>
  </formCode>
  <processNote>
    <number value="1"/>
    <type>
      <coding>
        <system value="http://hl7.org/fhir/note-type"/>
        <code value="display"/>
      </coding>
    </type>
    <text value="Invalid claim"/>
    <language>
      <coding>
        <system value="urn:ietf:bcp:47"/>
        <code value="en-CA"/>
      </coding>
    </language>
  </processNote>
</ExplanationOfBenefit>