<?xml version="1.0" encoding="UTF-8"?><ClaimResponse xmlns="http://hl7.org/fhir"><id value="696af5b7963b49969c0d70c27eeebc57"/><meta><versionId value="202"/><lastUpdated value="2021-03-07T12:38:06.682Z"/><security><system value="http://terminology.hl7.org/CodeSystem/v3-ActReason"/><code value="HTEST"/><display value="test health data"/></security></meta><text><status value="generated"/><h:div xmlns:h="http://www.w3.org/1999/xhtml">  
            <h:p>Touchstone Test Data - ClaimResponse: Pre-authorization Vision Claim Response</h:p> 
        </h:div></text><identifier><system value="http://benefitsinc.com/remittance"/><value value="3788109874-6986"/></identifier><status value="active"/><type><coding><system value="http://terminology.hl7.org/CodeSystem/claim-type"/><code value="vision"/></coding></type><use value="claim"/><patient><identifier><system value="http://happysight.com/patient"/><value value="3788109874-6986-2904979"/></identifier><display value="3788109874-6986-2904979"/></patient><created value="2018-12-26"/><insurer><identifier><system value="http://benefitsinc.com/certificate"/><value value="Pm1Yvlg7c6yk00gOlZL2904979"/></identifier><display value="Pm1Yvlg7c6yk00gOlZL2904979"/></insurer><request><identifier><system value="http://happysight.com/claim"/><value value="Pm1Yvlg7c6yk00gOlZL"/></identifier><display value="Pm1Yvlg7c6yk00gOlZL"/></request><outcome value="partial"/><disposition value="Pre-authorization completed as per coverage Pm1Yvlg7c6yk00gOlZL575769."/><payeeType><coding><system value="http://terminology.hl7.org/CodeSystem/payeetype"/><code value="subscriber"/></coding></payeeType><item><itemSequence value="1"/><adjudication><category><coding><system value="http://terminology.hl7.org/CodeSystem/adjudication"/><code value="eligible"/></coding></category><amount><value value="80.00"/><currency value="USD"/></amount></adjudication><adjudication><category><coding><system value="http://terminology.hl7.org/CodeSystem/adjudication"/><code value="copay"/></coding></category><amount><value value="10.00"/><currency value="USD"/></amount></adjudication><adjudication><category><coding><system value="http://terminology.hl7.org/CodeSystem/adjudication"/><code value="eligpercent"/></coding></category><value value="50.00"/></adjudication><adjudication><category><coding><system value="http://terminology.hl7.org/CodeSystem/adjudication"/><code value="benefit"/></coding></category><amount><value value="35.00"/><currency value="USD"/></amount></adjudication></item><total><category><coding><code value="submitted"/></coding></category><amount><value value="80.00"/><currency value="USD"/></amount></total><total><category><coding><code value="benefit"/></coding></category><amount><value value="35.00"/><currency value="USD"/></amount></total><payment><type><coding><system value="http://terminology.hl7.org/CodeSystem/ex-paymenttype"/><code value="partial"/></coding></type><date value="2018-12-26"/><amount><value value="35.00"/><currency value="USD"/></amount><identifier><system value="http://benefitsinc.com/paymentidentifier"/><value value="575769-2904979"/></identifier></payment></ClaimResponse>