<PaymentReconciliation xmlns="http://hl7.org/fhir">
  <id value="core-examples-PaymentReconciliation-example" />
  <meta>
    <versionId value="1" />
    <lastUpdated value="2016-09-08T11:38:16.102+00:00" />
  </meta>
  <text>
    <status value="generated" />
    <div xmlns="http://www.w3.org/1999/xhtml">A human-readable rendering of the PaymentReconciliation</div>
  </text>
  <identifier>
    <system value="http://www.benefitsinc.com/fhir/enrollmentresponse" />
    <value value="781234" />
  </identifier>
  <request>
    <reference value="http://www.benefitsinc.com/fhir/eligibility/225476332402" />
  </request>
  <outcome value="complete" />
  <disposition value="2014 August mid-month settlement." />
  <created value="2014-08-16" />
  <organization>
    <reference value="Organization/2" />
  </organization>
  <requestOrganization>
    <reference value="Organization/1" />
  </requestOrganization>
  <detail>
    <type>
      <system value="http://hl7.org/fhir/paymenttype" />
      <code value="payment" />
    </type>
    <request>
      <reference value="http://www.benefitsinc.com/fhir/oralhealthclaim/225476332402" />
    </request>
    <date value="2014-08-16" />
    <amount>
      <value value="1000.00" />
      <system value="urn:iso:std:iso:4217" />
      <code value="USD" />
    </amount>
  </detail>
  <detail>
    <type>
      <system value="http://hl7.org/fhir/paymenttype" />
      <code value="payment" />
    </type>
    <request>
      <reference value="http://www.benefitsinc.com/fhir/oralhealthclaim/225476332699" />
    </request>
    <date value="2014-08-12" />
    <amount>
      <value value="4000.00" />
      <system value="urn:iso:std:iso:4217" />
      <code value="USD" />
    </amount>
  </detail>
  <detail>
    <type>
      <system value="http://hl7.org/fhir/paymenttype" />
      <code value="advance" />
    </type>
    <date value="2014-08-16" />
    <amount>
      <value value="-1500.00" />
      <system value="urn:iso:std:iso:4217" />
      <code value="USD" />
    </amount>
  </detail>
  <total>
    <value value="3500.00" />
    <system value="urn:iso:std:iso:4217" />
    <code value="USD" />
  </total>
</PaymentReconciliation>