Untitled

<?xml version="1.0" encoding="UTF-8"?>
<Envelope xmlns="http://www.w3.org/2003/05/soap-envelope" xmlna="http://www.w3.org/2005/08/addressing">
   <Header>
      <Action mustUnderstand="1">http://services.activus.com/claimsloadservice/servicecontracts/2011/05/ActClaimsLoadServiceContract/GetInvoiceLinesResponse</Action>
      <ActisureHeader xmlnh="http://services.activus.com/claimsloadservice/servicecontracts/2011/05" xmlni="http://www.w3.org/2001/XMLSchema-instance">
         <ExternalRefID xmlns="http://services.activus.com/common/datacontracts/2010/02">XYZ</ExternalRefID>
         <Source xmlns="http://services.activus.com/common/datacontracts/2010/02">BATCH</Source>
         <InternalRefID xmlns="http://services.activus.com/common/datacontracts/2010/02">123</InternalRefID>
      </ActisureHeader>
   </Header>
   <Body>
      <GetInvoiceLinesResponseMessage xmlns="http://services.activus.com/claimsloadservice/messagecontracts/2011/05">
         <GetInvoiceLinesResponse xmlns="http://services.activus.com/claimsloadservice/servicecontracts/2011/05" xmlnb="http://services.activus.com/claimsloadservice/datacontracts/2011/05" xmlni="http://www.w3.org/2001/XMLSchema-instance">
            <CommonResponse xmlnc="http://services.activus.com/common/datacontracts/2010/02">
               <ActServiceResult>
                  <Success>true</Success>
                  <ResponseCode nil="true" />
                  <Message nil="true" />
               </ActServiceResult>
               <BusinessErrors />
               <RequestReference>?</RequestReference>
            </CommonResponse>
            <InvoiceLines xmlnc="http://schemas.activus.com/dispublicobject/claimsload/2011/05">
               <InvoiceLineOnly>
                  <InvoiceId>15174094</InvoiceId>
                  <InvoiceLineId>110114532</InvoiceLineId>
                  <Status>Paid</Status>
                  <Quantity>1</Quantity>
                  <BenefitId>340</BenefitId>
                  <BenefitName>Outpatient Enhanced II Shared</BenefitName>
                  <SubBenefitId>2589</SubBenefitId>
                  <SubBenefitName>Illness Outpatient</SubBenefitName>
                  <BenefitDetailId>39976</BenefitDetailId>
                  <BenefitDetailName>Prescription</BenefitDetailName>
                  <Amount>150</Amount>
                  <DeniedAmount>0</DeniedAmount>
                  <SettledAmount>150</SettledAmount>
                  <RevenueCodeDescription />
                  <ServiceDate>2019-08-16T00:00:00</ServiceDate>
                  <ServiceEndDate>2019-08-16T00:00:00</ServiceEndDate>
                  <PolicyExcessApplied>0</PolicyExcessApplied>
                  <CoInsuranceAmount>0</CoInsuranceAmount>
                  <BenefitExcessApplied>0</BenefitExcessApplied>
                  <BenefitServiceCode nil="true" />
                  <BenefitServiceDescription nil="true" />
                  <BenefitServiceId>0</BenefitServiceId>
                  <InvoiceLineSequenceId>3</InvoiceLineSequenceId>
                  <BenefitServiceCategoryDescription nil="true" />
                  <GrossAmount>150</GrossAmount>
                  <PreAdjudicationDiscount>0</PreAdjudicationDiscount>
                  <IsPreDiscountAnAmount>true</IsPreDiscountAnAmount>
                  <UserStatus>Paid</UserStatus>
                  <ReasonCode>0</ReasonCode>
                  <ReasonSource>codeset</ReasonSource>
                  <ReasonText>Delivery Fee</ReasonText>
                  <AdditionalDeductions />
               </InvoiceLineOnly>
               <InvoiceLineOnly>
                  <InvoiceId>15174094</InvoiceId>
                  <InvoiceLineId>110114531</InvoiceLineId>
                  <Status>Paid</Status>
                  <Quantity>1</Quantity>
                  <BenefitId>340</BenefitId>
                  <BenefitName>Outpatient Enhanced II Shared</BenefitName>
                  <SubBenefitId>2589</SubBenefitId>
                  <SubBenefitName>Illness Outpatient</SubBenefitName>
                  <BenefitDetailId>39976</BenefitDetailId>
                  <BenefitDetailName>Prescription</BenefitDetailName>
                  <Amount>20</Amount>
                  <DeniedAmount>0</DeniedAmount>
                  <SettledAmount>20</SettledAmount>
                  <RevenueCodeDescription />
                  <ServiceDate>2019-08-16T00:00:00</ServiceDate>
                  <ServiceEndDate>2019-08-16T00:00:00</ServiceEndDate>
                  <PolicyExcessApplied>0</PolicyExcessApplied>
                  <CoInsuranceAmount>0</CoInsuranceAmount>
                  <BenefitExcessApplied>0</BenefitExcessApplied>
                  <BenefitServiceCode nil="true" />
                  <BenefitServiceDescription nil="true" />
                  <BenefitServiceId>0</BenefitServiceId>
                  <InvoiceLineSequenceId>2</InvoiceLineSequenceId>
                  <BenefitServiceCategoryDescription nil="true" />
                  <GrossAmount>20</GrossAmount>
                  <PreAdjudicationDiscount>0</PreAdjudicationDiscount>
                  <IsPreDiscountAnAmount>true</IsPreDiscountAnAmount>
                  <UserStatus>Paid</UserStatus>
                  <ReasonCode>28</ReasonCode>
                  <ReasonSource>codeset</ReasonSource>
                  <ReasonText>Administrative Fee</ReasonText>
                  <AdditionalDeductions />
               </InvoiceLineOnly>
               <InvoiceLineOnly>
                  <InvoiceId>15174094</InvoiceId>
                  <InvoiceLineId>110114530</InvoiceLineId>
                  <Status>NP - Not to be Paid</Status>
                  <Quantity>18</Quantity>
                  <BenefitId>340</BenefitId>
                  <BenefitName>Outpatient Enhanced II Shared</BenefitName>
                  <SubBenefitId>2589</SubBenefitId>
                  <SubBenefitName>Illness Outpatient</SubBenefitName>
                  <BenefitDetailId>39976</BenefitDetailId>
                  <BenefitDetailName>Prescription</BenefitDetailName>
                  <Amount>0</Amount>
                  <DeniedAmount>0</DeniedAmount>
                  <SettledAmount>0</SettledAmount>
                  <RevenueCodeDescription />
                  <ServiceDate>2019-08-16T00:00:00</ServiceDate>
                  <ServiceEndDate>2019-08-16T00:00:00</ServiceEndDate>
                  <PolicyExcessApplied>0</PolicyExcessApplied>
                  <CoInsuranceAmount>0</CoInsuranceAmount>
                  <BenefitExcessApplied>0</BenefitExcessApplied>
                  <BenefitServiceCode nil="true" />
                  <BenefitServiceDescription nil="true" />
                  <BenefitServiceId>0</BenefitServiceId>
                  <InvoiceLineSequenceId>1</InvoiceLineSequenceId>
                  <BenefitServiceCategoryDescription nil="true" />
                  <GrossAmount>12</GrossAmount>
                  <PreAdjudicationDiscount>12</PreAdjudicationDiscount>
                  <IsPreDiscountAnAmount>true</IsPreDiscountAnAmount>
                  <UserStatus>NP - Not to be Paid</UserStatus>
                  <ReasonCode>28</ReasonCode>
                  <ReasonSource>codeset</ReasonSource>
                  <ReasonText>AUROXONE 1000 (Ceftriaxone for Injection USP 1000 mg) (0.66666666666667 * 18 = 12)</ReasonText>
                  <AdditionalDeductions />
               </InvoiceLineOnly>
            </InvoiceLines>
         </GetInvoiceLinesResponse>
      </GetInvoiceLinesResponseMessage>
   </Body>
</Envelope>