{
  "resourceType": "CoverageEligibilityResponse",
  "id": "E2503",
  "text": {
    "status": "generated",
    "div": "\u003cdiv xmlns\u003d\"http://www.w3.org/1999/xhtml\"\u003eA human-readable rendering of the CoverageEligibilityResponse.\u003c/div\u003e"
  },
  "identifier": [
    {
      "system": "http://www.BenefitsInc.com/fhir/coverageeligibilityresponse",
      "value": "8812343"
    }
  ],
  "status": "active",
  "purpose": [
    "validation"
  ],
  "patient": {
    "reference": "Patient/f201"
  },
  "created": "2014-09-16",
  "requestor": {
    "identifier": {
      "system": "http://national.org/clinic",
      "value": "OR1234"
    }
  },
  "request": {
    "reference": "http://www.BenefitsInc.com/fhir/coverageeligibilityresponse/225476332406"
  },
  "outcome": "error",
  "disposition": "Eligibiliy request could not be processed, please address errors before submitting.",
  "insurer": {
    "reference": "Organization/2"
  },
  "form": {
    "coding": [
      {
        "system": "http://national.org/form",
        "code": "ELRSP/2017/01"
      }
    ]
  },
  "error": [
    {
      "code": {
        "coding": [
          {
            "system": "http://terminology.hl7.org/CodeSystem/adjudication-error",
            "code": "a001"
          }
        ]
      }
    }
  ],
  "meta": {
    "tag": [
      {
        "system": "http://terminology.hl7.org/CodeSystem/v3-ActReason",
        "code": "HTEST",
        "display": "test health data"
      }
    ]
  }
}