{
  "resourceType": "PaymentNotice",
  "id": "77654",
  "text": {
    "status": "generated",
    "div": "\u003cdiv xmlns\u003d\"http://www.w3.org/1999/xhtml\"\u003eA human-readable rendering of the PaymentNotice\u003c/div\u003e"
  },
  "identifier": [
    {
      "system": "http://benefitsinc.com/paymentnotice",
      "value": "776543"
    }
  ],
  "status": "active",
  "request": {
    "reference": "http://benefitsinc.com/fhir/claim/12345"
  },
  "response": {
    "reference": "http://benefitsinc.com/fhir/claimresponse/CR12345"
  },
  "created": "2014-08-16",
  "reporter": {
    "reference": "Organization/1"
  },
  "payment": {
    "reference": "PaymentReconciliation/ER2500"
  },
  "paymentDate": "2014-08-15",
  "payee": {
    "reference": "Organization/1"
  },
  "recipient": {
    "identifier": {
      "system": "http://regulators.gov",
      "value": "AB123"
    }
  },
  "amount": {
    "value": 12500.00,
    "currency": "USD"
  },
  "paymentStatus": {
    "coding": [
      {
        "system": "http://terminology.hl7.org/CodeSystem/paymentstatus",
        "code": "paid"
      }
    ]
  },
  "meta": {
    "tag": [
      {
        "system": "http://terminology.hl7.org/CodeSystem/v3-ActReason",
        "code": "HTEST",
        "display": "test health data"
      }
    ]
  }
}