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

<id value="SR2349"/>

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

<identifier>
        <system value="http://www.BenefitsInc.com/fhir/processresponse"/>
        <value value="ER987634"/>
</identifier>

<status value="active"/>

<created value="2014-07-14"/>

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

<request>
        <reference value="http://happyvalley.com/fhir/claim/12204"/>
</request>

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

<disposition value="Referred to claim not found on system."/>

<requestProvider>
        <identifier>
                <system value="http://npid.org/providerid"/>
                <value value="AZ43258"/>
        </identifier>
</requestProvider>

<requestOrganization>
        <reference value="Organization/1"/>
</requestOrganization>

<form>
        <coding>
                <system value="http://ncforms.org/formid"/>
                <code value="PRRESP/2016/01"/>
        </coding>
</form>

<processNote>
        <type>
                <coding>
                        <system value="http://hl7.org/fhir/note-type"/>
                        <code value="print"/>
                </coding>
        </type>
        <text value="Please check the submitted payor identification and local claim number."/>
</processNote>

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

</ProcessResponse>