<ExplanationOfBenefit xmlns="http://hl7.org/fhir" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xsi:schemaLocation="http://hl7.org/fhir ../../input-cache/schemas/R5/fhir-single.xsd">
  <!-- id will typically be omitted.  It is included here due to publishing requiremeents -->
  <id value="example-ExplanationOfBenefit-expenses" />
  <contained>
    <Provenance>
      <id value="1" />
      <target>
        <reference value="#" />
      </target>
      <occurredDateTime value="2021-11-22T15:52:27.94433-04:00" />
      <activity>
        <coding>
          <system value="http://terminology.hl7.org/CodeSystem/v3-DataOperation" />
          <code value="CREATE" />
        </coding>
      </activity>
      <agent>
        <who>
          <identifier>
            <system value="https://bpcs.exchange/fhir/NamingSystem/userids" />
            <value value="M_MBPCS" />
          </identifier>
        </who>
      </agent>
    </Provenance>
  </contained>
  <contained>
    <Provenance>
      <id value="2" />
      <target>
        <reference value="#" />
      </target>
      <occurredDateTime value="2023-09-18T13:07:22.796796-04:00" />
      <activity>
        <coding>
          <system value="http://terminology.hl7.org/CodeSystem/v3-DataOperation" />
          <code value="UPDATE" />
        </coding>
      </activity>
      <agent>
        <who>
          <identifier>
            <system value="https://bpcs.exchange/fhir/NamingSystem/userids" />
            <value value="M_MBPCS" />
          </identifier>
        </who>
      </agent>
    </Provenance>
  </contained>
  <status value="active" />
  <type>
    <coding>
      <system value="http://terminology.hl7.org/CodeSystem/claim-type" />
      <code value="pharmacy" />
    </coding>
  </type>
  <use value="claim" />
  <patient>
    <!-- The id will typically be an odbNum -->
    <reference value="Patient/example-Patient" />
  </patient>
  <created value="2023-08-16T13:27:37-04:00" />
  <insurer>
    <reference value="Organization/bpcs" />
  </insurer>
  <outcome value="complete" />
  <total>
    <category>
      <coding>
        <system value="http://terminology.hl7.org/CodeSystem/adjudication" />
        <code value="eligible" />
      </coding>
    </category>
    <amount>
      <value value="123" />
    </amount>
  </total>
  <benefitPeriod>
    <start value="2022-08-01" />
    <end value="2023-07-31" />
  </benefitPeriod>
</ExplanationOfBenefit>