{

"resourceType": "EligibilityResponse",
"id": "E2503",
"text": {
  "status": "generated",
  "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">A human-readable rendering of the EligibilityResponse.</div>"
},
"identifier": [
  {
    "system": "http://www.BenefitsInc.com/fhir/eligibilityresponse",
    "value": "8812343"
  }
],
"status": "active",
"created": "2014-09-16",
"requestProvider": {
  "identifier": {
    "system": "http://national.org/provider",
    "value": "PR9876"
  }
},
"requestOrganization": {
  "identifier": {
    "system": "http://national.org/clinic",
    "value": "OR1234"
  }
},
"request": {
  "reference": "http://www.BenefitsInc.com/fhir/EligibilityRequest/225476332406"
},
"outcome": {
  "coding": [
    {
      "system": "http://hl7.org/fhir/remittance-outcome",
      "code": "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://hl7.org/fhir/adjudication-error",
          "code": "a001"
        }
      ]
    }
  }
]

}