Kenya eClaims FHIR IG
0.1.0 - ci-build
Kenya eClaims FHIR IG
0.1.0 - ci-build
Kenya eClaims FHIR IG, published by iclKenya. This guide is not an authorized publication; it is the continuous build for version 0.1.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/IntelliSOFT-Consulting/Kenya-eClaims-FHIR-IG/ and changes regularly. See the Directory of published versions
{
"resourceType" : "Claim",
"id" : "CR-00001",
"meta" : {
"profile" : [
🔗 "https://example.com/fhir/StructureDefinition/eclaims-claim",
"http://fhir.sha.go.ke/fhir/StructureDefinition/eclaims-claim"
]
},
"text" : {
"status" : "generated",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p class=\"res-header-id\"><b>Generated Narrative: Claim CR-00001</b></p><a name=\"CR-00001\"> </a><a name=\"hcCR-00001\"> </a><div style=\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\"><p style=\"margin-bottom: 0px\"/><p style=\"margin-bottom: 0px\">Profiles: <a href=\"StructureDefinition-eclaims-claim.html\">Claim Response - Preauthorization</a>, <code>http://fhir.sha.go.ke/fhir/StructureDefinition/eclaims-claim</code></p></div><p><b>identifier</b>: <code>http://fhir.sha.go.ke/fhir/Identifier/claim-number</code>/CLAIM-00001</p><p><b>status</b>: Active</p><p><b>type</b>: <span title=\"Codes:{http://fhir.sha.go.ke/fhir/CodeSystem/claim-type institutional}\">Institutional Claim</span></p><p><b>subType</b>: <span title=\"Codes:{http://fhir.sha.go.ke/fhir/CodeSystem/claim-subtype inpatient}\">Inpatient</span></p><p><b>use</b>: Preauthorization</p><p><b>patient</b>: <a href=\"Patient/PT-0001\">Patient/PT-0001</a></p><p><b>billablePeriod</b>: 2025-11-01 --> 2025-11-30</p><p><b>created</b>: 2025-12-16 12:00:00+0300</p><p><b>insurer</b>: <a href=\"Organization/INS-001\">Organization/INS-001</a></p><p><b>provider</b>: <a href=\"Organization/ORG-001\">Organization/ORG-001</a></p><p><b>priority</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/processpriority routine}\">Routine</span></p><h3>Relateds</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Claim</b></td><td><b>Relationship</b></td></tr><tr><td style=\"display: none\">*</td><td><a href=\"Claim/CLAIM-0000X\">Claim/CLAIM-0000X</a></td><td><span title=\"Codes:{http://fhir.sha.go.ke/fhir/CodeSystem/claim-relation-type claim}\">Claim</span></td></tr></table><p><b>originalPrescription</b>: <a href=\"MedicationRequest/MED-0001\">MedicationRequest/MED-0001</a></p><h3>Payees</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Type</b></td><td><b>Party</b></td></tr><tr><td style=\"display: none\">*</td><td><span title=\"Codes:{http://fhir.sha.go.ke/fhir/CodeSystem/payee-type provider}\">Provider</span></td><td><a href=\"Organization/ORG-001\">Organization/ORG-001</a></td></tr></table><p><b>referral</b>: <a href=\"ServiceRequest/SRV-0001\">ServiceRequest/SRV-0001</a></p><p><b>facility</b>: <a href=\"Location/LOC-001\">Location/LOC-001</a></p><h3>CareTeams</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Sequence</b></td><td><b>Provider</b></td><td><b>Role</b></td><td><b>Qualification</b></td></tr><tr><td style=\"display: none\">*</td><td>1</td><td><a href=\"Practitioner/PRA-001\">Practitioner/PRA-001</a></td><td><span title=\"Codes:{http://terminology.hl7.org/CodeSystem/claimcareteamrole primary}\">Primary Provider</span></td><td><span title=\"Codes:{http://terminology.hl7.org/CodeSystem/v2-0360/2.7 MD}\">Medical Doctor</span></td></tr></table><h3>SupportingInfos</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Sequence</b></td><td><b>Category</b></td><td><b>Value[x]</b></td></tr><tr><td style=\"display: none\">*</td><td>1</td><td><span title=\"Codes:{http://terminology.hl7.org/CodeSystem/claiminformationcategory attachment}\">Attachment</span></td><td>application-pdf @ https://api-edi.provider.sha.go.ke/media/claim/CHURCHILL_X-RAY.pdf</td></tr></table><h3>Diagnoses</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Sequence</b></td><td><b>Diagnosis[x]</b></td><td><b>Type</b></td></tr><tr><td style=\"display: none\">*</td><td>1</td><td><span title=\"Codes:{https://fhir.sha.go.ke/fhir/terminology/CodeSystem/icd-11 NC72.5}\">Fracture of shaft of femur</span></td><td><span title=\"Codes:{http://terminology.hl7.org/CodeSystem/ex-diagnosistype principal}\">Principal Diagnosis</span></td></tr></table><h3>Insurances</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Sequence</b></td><td><b>Focal</b></td><td><b>Coverage</b></td></tr><tr><td style=\"display: none\">*</td><td>1</td><td>true</td><td><a href=\"Coverage/COV-0001\">Coverage/COV-0001</a></td></tr></table><blockquote><p><b>item</b></p><p><b>sequence</b>: 1</p><p><b>careTeamSequence</b>: 1</p><p><b>productOrService</b>: <span title=\"Codes:{https://fhir.sha.go.ke/fhir/CodeSystem/intervention-codes SHA-19-444}\">Open reduction and internal fixation: Femur</span></p><p><b>quantity</b>: 1</p><h3>UnitPrices</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style=\"display: none\">*</td><td>145600</td><td>Kenyan shilling</td></tr></table><h3>Nets</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style=\"display: none\">*</td><td>145600</td><td>Kenyan shilling</td></tr></table></blockquote><h3>Totals</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style=\"display: none\">*</td><td>145600</td><td>Kenyan shilling</td></tr></table></div>"
},
"identifier" : [
{
"system" : "http://fhir.sha.go.ke/fhir/Identifier/claim-number",
"value" : "CLAIM-00001"
}
],
"status" : "active",
"type" : {
"coding" : [
{
"system" : "http://fhir.sha.go.ke/fhir/CodeSystem/claim-type",
"code" : "institutional",
"display" : "Institutional Claim"
}
]
},
"subType" : {
"coding" : [
{
"system" : "http://fhir.sha.go.ke/fhir/CodeSystem/claim-subtype",
"code" : "inpatient",
"display" : "Inpatient"
}
]
},
"use" : "preauthorization",
"patient" : {
"reference" : "Patient/PT-0001"
},
"billablePeriod" : {
"start" : "2025-11-01",
"end" : "2025-11-30"
},
"created" : "2025-12-16T12:00:00+03:00",
"insurer" : {
"reference" : "Organization/INS-001"
},
"provider" : {
"reference" : "Organization/ORG-001"
},
"priority" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/processpriority",
"code" : "routine",
"display" : "Routine"
}
]
},
"related" : [
{
"claim" : {
"reference" : "Claim/CLAIM-0000X"
},
"relationship" : {
"coding" : [
{
"system" : "http://fhir.sha.go.ke/fhir/CodeSystem/claim-relation-type",
"code" : "claim",
"display" : "Claim"
}
]
}
}
],
"originalPrescription" : {
"reference" : "MedicationRequest/MED-0001"
},
"payee" : {
"type" : {
"coding" : [
{
"system" : "http://fhir.sha.go.ke/fhir/CodeSystem/payee-type",
"code" : "provider",
"display" : "Provider"
}
]
},
"party" : {
"reference" : "Organization/ORG-001"
}
},
"referral" : {
"reference" : "ServiceRequest/SRV-0001"
},
"facility" : {
"reference" : "Location/LOC-001"
},
"careTeam" : [
{
"sequence" : 1,
"provider" : {
"reference" : "Practitioner/PRA-001"
},
"role" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/claimcareteamrole",
"code" : "primary",
"display" : "Primary Provider"
}
]
},
"qualification" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/v2-0360/2.7",
"code" : "MD",
"display" : "Medical Doctor"
}
]
}
}
],
"supportingInfo" : [
{
"sequence" : 1,
"category" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/claiminformationcategory",
"code" : "attachment",
"display" : "Attachment"
}
]
},
"valueAttachment" : {
"contentType" : "application-pdf",
"url" : "https://api-edi.provider.sha.go.ke/media/claim/CHURCHILL_X-RAY.pdf",
"title" : "CHURCHILL X-RAY",
"creation" : "2025-11-29T15:17:07+03:00"
}
}
],
"diagnosis" : [
{
"sequence" : 1,
"diagnosisCodeableConcept" : {
"coding" : [
{
"system" : "https://fhir.sha.go.ke/fhir/terminology/CodeSystem/icd-11",
"code" : "NC72.5",
"display" : "Fracture of shaft of femur"
}
]
},
"type" : [
{
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/ex-diagnosistype",
"code" : "principal",
"display" : "Principal Diagnosis"
}
]
}
]
}
],
"insurance" : [
{
"sequence" : 1,
"focal" : true,
"coverage" : {
"reference" : "Coverage/COV-0001"
}
}
],
"item" : [
{
"sequence" : 1,
"careTeamSequence" : [
1
],
"productOrService" : {
"coding" : [
{
"system" : "https://fhir.sha.go.ke/fhir/CodeSystem/intervention-codes",
"code" : "SHA-19-444",
"display" : "Open reduction and internal fixation: Femur"
}
]
},
"quantity" : {
"value" : 1
},
"unitPrice" : {
"value" : 145600,
"currency" : "KES"
},
"net" : {
"value" : 145600,
"currency" : "KES"
}
}
],
"total" : {
"value" : 145600,
"currency" : "KES"
}
}