<?xml version=“1.0” encoding=“UTF-8”?><EligibilityResponse xmlns=“hl7.org/fhir”>

<id value="E2503"/>

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

<identifier>
        <system value="http://www.BenefitsInc.com/fhir/eligibilityresponse"/>
        <value value="8812343"/>
</identifier>

<status value="active"/>

<created value="2014-09-16"/>

<requestProvider>
        <identifier>
                <system value="http://national.org/provider"/>
                <value value="PR9876"/>
        </identifier>  
</requestProvider>

<requestOrganization> 
        <identifier>
                <system value="http://national.org/clinic"/>
                <value value="OR1234"/>
        </identifier>   
</requestOrganization>

<request>
        <reference value="http://www.BenefitsInc.com/fhir/EligibilityRequest/225476332406"/>
</request>

<outcome>
        <coding>
                <system value="http://hl7.org/fhir/remittance-outcome"/>
                <code value="error"/>
        </coding>
</outcome>

<disposition value="Eligibiliy request could not be processed, please address errors before submitting."/>

<insurer>
        <reference value="Organization/2"/>
</insurer>

<form>
        <coding>
                <system value="http://national.org/form"/>
                <code value="ELRSP/2017/01"/>
        </coding>
</form>

<error>
        <code>
                <coding>
                        <system value="http://hl7.org/fhir/adjudication-error"/>
                        <code value="a001"/>
                </coding>
        </code>
</error>

</EligibilityResponse>