Example Claim Response - TTL Representation - Kenya eClaims Implementation Guide v0.1.0

Kenya eClaims Implementation Guide, published by Digital Health Agency (DHA), Kenya. 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
: Example Claim Response - TTL Representation

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@prefix fhir: <http://hl7.org/fhir/> .
@prefix owl: <http://www.w3.org/2002/07/owl#> .
@prefix rdfs: <http://www.w3.org/2000/01/rdf-schema#> .
@prefix xsd: <http://www.w3.org/2001/XMLSchema#> .

# - resource -------------------------------------------------------------------

<http://hl7.org/fhir/Claim/CR-00001> a fhir:Claim ;
  fhir:nodeRole fhir:treeRoot ;
  fhir:Resource.id [ fhir:value "CR-00001"] ;
  fhir:Resource.meta [
     fhir:Meta.profile [
       fhir:value "https://fhir.dha.go.ke/ig/eclaims/StructureDefinition/ke-eclaims-claim" ;
       fhir:index 0 ;
       fhir:link <https://fhir.dha.go.ke/ig/eclaims/StructureDefinition/ke-eclaims-claim>
     ], [
       fhir:value "https://nshr-uat.sha.go.ke/fhir/StructureDefinition/ke-eclaims-claim" ;
       fhir:index 1 ;
       fhir:link <https://nshr-uat.sha.go.ke/fhir/StructureDefinition/ke-eclaims-claim>
     ]
  ] ;
  fhir:DomainResource.text [
     fhir:Narrative.status [ fhir:value "generated" ] ;
     fhir:Narrative.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-ke-eclaims-claim.html\">Claim Response - Preauthorization</a>, <code>https://nshr-uat.sha.go.ke/fhir/StructureDefinition/ke-eclaims-claim</code></p></div><p><b>identifier</b>: <code>https://nshr-uat.sha.go.ke/fhir/Identifier/claim-number</code>/CLAIM-00001</p><p><b>status</b>: Active</p><p><b>type</b>: <span title=\"Codes:{https://nshr-uat.sha.go.ke/fhir/CodeSystem/claim-type-cs institutional}\">Institutional</span></p><p><b>subType</b>: <span title=\"Codes:{https://nshr-uat.sha.go.ke/fhir/CodeSystem/claim-subtype-cs inpatient}\">Inpatient</span></p><p><b>use</b>: Preauthorization</p><p><b>patient</b>: <a href=\"Patient-PT-0001.html\">John Doe  Male, DoB: 1980-01-01</a></p><p><b>billablePeriod</b>: 2025-11-01 --&gt; 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.html\">Organization Kenya Insurance Company</a></p><p><b>provider</b>: <a href=\"Organization-ORG-001.html\">Organization Nairobi General Hospital</a></p><p><b>priority</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/processpriority normal}\">Normal</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.html\">Claim: status = active; type = Institutional; use = claim; created = 2025-01-01; priority = Normal</a></td><td><span title=\"Codes:{https://nshr-uat.sha.go.ke/fhir/CodeSystem/related-claim-relationship-cs associated}\">Associated</span></td></tr></table><p><b>originalPrescription</b>: <a href=\"MedicationRequest-MED-0001.html\">MedicationRequest: status = active; intent = order; medication[x] = </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://terminology.hl7.org/CodeSystem/payeetype provider}\">Provider</span></td><td><a href=\"Organization-ORG-001.html\">Organization Nairobi General Hospital</a></td></tr></table><p><b>referral</b>: <a href=\"ServiceRequest-SRV-0001.html\">ServiceRequest </a></p><p><b>facility</b>: <a href=\"Location-LOC-001.html\">Location Main Ward</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.html\">Practitioner Dr. James Kamau </a></td><td><span title=\"Codes:{https://nshr-uat.sha.go.ke/fhir/CodeSystem/claim-care-team-role-cs PRIMARY}\">Primary provider</span></td><td><span title=\"Codes:{https://nshr-uat.sha.go.ke/fhir/CodeSystem/eclaims-provider-qualification-cs MD}\">Doctor of Medicine</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 @ <a href=\"https://api-edi.provider.sha.go.ke/media/claim/CHURCHILL_X-RAY.pdf\">https://api-edi.provider.sha.go.ke/media/claim/CHURCHILL_X-RAY.pdf <img src=\"external.png\" alt=\"icon\" style=\"vertical-align: baseline\"/></a></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://nshr-uat.sha.go.ke/fhir/CodeSystem/icd11-codes-cs 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.html\">Coverage: status = active</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://nshr-uat.sha.go.ke/fhir/CodeSystem/KenyaSocialHealthAuthorityInterventionCS 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>"
  ] ;
  fhir:Claim.identifier [
     fhir:index 0 ;
     fhir:Identifier.system [ fhir:value "https://nshr-uat.sha.go.ke/fhir/Identifier/claim-number" ] ;
     fhir:Identifier.value [ fhir:value "CLAIM-00001" ]
  ] ;
  fhir:Claim.status [ fhir:value "active"] ;
  fhir:Claim.type [
     fhir:CodeableConcept.coding [
       fhir:index 0 ;
       fhir:Coding.system [ fhir:value "https://nshr-uat.sha.go.ke/fhir/CodeSystem/claim-type-cs" ] ;
       fhir:Coding.code [ fhir:value "institutional" ] ;
       fhir:Coding.display [ fhir:value "Institutional" ]
     ]
  ] ;
  fhir:Claim.subType [
     fhir:CodeableConcept.coding [
       fhir:index 0 ;
       fhir:Coding.system [ fhir:value "https://nshr-uat.sha.go.ke/fhir/CodeSystem/claim-subtype-cs" ] ;
       fhir:Coding.code [ fhir:value "inpatient" ] ;
       fhir:Coding.display [ fhir:value "Inpatient" ]
     ]
  ] ;
  fhir:Claim.use [ fhir:value "preauthorization"] ;
  fhir:Claim.patient [
     fhir:link <http://hl7.org/fhir/Patient/PT-0001> ;
     fhir:Reference.reference [ fhir:value "Patient/PT-0001" ]
  ] ;
  fhir:Claim.billablePeriod [
     fhir:Period.start [ fhir:value "2025-11-01"^^xsd:date ] ;
     fhir:Period.end [ fhir:value "2025-11-30"^^xsd:date ]
  ] ;
  fhir:Claim.created [ fhir:value "2025-12-16T12:00:00+03:00"^^xsd:dateTime] ;
  fhir:Claim.insurer [
     fhir:link <http://hl7.org/fhir/Organization/INS-001> ;
     fhir:Reference.reference [ fhir:value "Organization/INS-001" ]
  ] ;
  fhir:Claim.provider [
     fhir:link <http://hl7.org/fhir/Organization/ORG-001> ;
     fhir:Reference.reference [ fhir:value "Organization/ORG-001" ]
  ] ;
  fhir:Claim.priority [
     fhir:CodeableConcept.coding [
       fhir:index 0 ;
       fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/processpriority" ] ;
       fhir:Coding.code [ fhir:value "normal" ] ;
       fhir:Coding.display [ fhir:value "Normal" ]
     ]
  ] ;
  fhir:Claim.related [
     fhir:index 0 ;
     fhir:Claim.related.claim [
       fhir:link <http://hl7.org/fhir/Claim/CLAIM-0000X> ;
       fhir:Reference.reference [ fhir:value "Claim/CLAIM-0000X" ]
     ] ;
     fhir:Claim.related.relationship [
       fhir:CodeableConcept.coding [
         fhir:index 0 ;
         fhir:Coding.system [ fhir:value "https://nshr-uat.sha.go.ke/fhir/CodeSystem/related-claim-relationship-cs" ] ;
         fhir:Coding.code [ fhir:value "associated" ] ;
         fhir:Coding.display [ fhir:value "Associated" ]
       ]
     ]
  ] ;
  fhir:Claim.originalPrescription [
     fhir:link <http://hl7.org/fhir/MedicationRequest/MED-0001> ;
     fhir:Reference.reference [ fhir:value "MedicationRequest/MED-0001" ]
  ] ;
  fhir:Claim.payee [
     fhir:Claim.payee.type [
       fhir:CodeableConcept.coding [
         fhir:index 0 ;
         fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/payeetype" ] ;
         fhir:Coding.code [ fhir:value "provider" ] ;
         fhir:Coding.display [ fhir:value "Provider" ]
       ]
     ] ;
     fhir:Claim.payee.party [
       fhir:link <http://hl7.org/fhir/Organization/ORG-001> ;
       fhir:Reference.reference [ fhir:value "Organization/ORG-001" ]
     ]
  ] ;
  fhir:Claim.referral [
     fhir:link <http://hl7.org/fhir/ServiceRequest/SRV-0001> ;
     fhir:Reference.reference [ fhir:value "ServiceRequest/SRV-0001" ]
  ] ;
  fhir:Claim.facility [
     fhir:link <http://hl7.org/fhir/Location/LOC-001> ;
     fhir:Reference.reference [ fhir:value "Location/LOC-001" ]
  ] ;
  fhir:Claim.careTeam [
     fhir:index 0 ;
     fhir:Claim.careTeam.sequence [ fhir:value "1"^^xsd:positiveInteger ] ;
     fhir:Claim.careTeam.provider [
       fhir:link <http://hl7.org/fhir/Practitioner/PRA-001> ;
       fhir:Reference.reference [ fhir:value "Practitioner/PRA-001" ]
     ] ;
     fhir:Claim.careTeam.role [
       fhir:CodeableConcept.coding [
         fhir:index 0 ;
         fhir:Coding.system [ fhir:value "https://nshr-uat.sha.go.ke/fhir/CodeSystem/claim-care-team-role-cs" ] ;
         fhir:Coding.code [ fhir:value "PRIMARY" ] ;
         fhir:Coding.display [ fhir:value "Primary provider" ]
       ]
     ] ;
     fhir:Claim.careTeam.qualification [
       fhir:CodeableConcept.coding [
         fhir:index 0 ;
         fhir:Coding.system [ fhir:value "https://nshr-uat.sha.go.ke/fhir/CodeSystem/eclaims-provider-qualification-cs" ] ;
         fhir:Coding.code [ fhir:value "MD" ] ;
         fhir:Coding.display [ fhir:value "Doctor of Medicine" ]
       ]
     ]
  ] ;
  fhir:Claim.supportingInfo [
     fhir:index 0 ;
     fhir:Claim.supportingInfo.sequence [ fhir:value "1"^^xsd:positiveInteger ] ;
     fhir:Claim.supportingInfo.category [
       fhir:CodeableConcept.coding [
         fhir:index 0 ;
         fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/claiminformationcategory" ] ;
         fhir:Coding.code [ fhir:value "attachment" ] ;
         fhir:Coding.display [ fhir:value "Attachment" ]
       ]
     ] ;
     fhir:Claim.supportingInfo.valueAttachment [
       fhir:Attachment.contentType [ fhir:value "application/pdf" ] ;
       fhir:Attachment.url [ fhir:value "https://api-edi.provider.sha.go.ke/media/claim/CHURCHILL_X-RAY.pdf" ] ;
       fhir:Attachment.title [ fhir:value "CHURCHILL X-RAY" ] ;
       fhir:Attachment.creation [ fhir:value "2025-11-29T15:17:07+03:00"^^xsd:dateTime ]
     ]
  ] ;
  fhir:Claim.diagnosis [
     fhir:index 0 ;
     fhir:Claim.diagnosis.sequence [ fhir:value "1"^^xsd:positiveInteger ] ;
     fhir:Claim.diagnosis.diagnosisCodeableConcept [
       fhir:CodeableConcept.coding [
         fhir:index 0 ;
         fhir:Coding.system [ fhir:value "https://nshr-uat.sha.go.ke/fhir/CodeSystem/icd11-codes-cs" ] ;
         fhir:Coding.code [ fhir:value "NC72.5" ] ;
         fhir:Coding.display [ fhir:value "Fracture of shaft of femur" ]
       ]
     ] ;
     fhir:Claim.diagnosis.type [
       fhir:index 0 ;
       fhir:CodeableConcept.coding [
         fhir:index 0 ;
         fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/ex-diagnosistype" ] ;
         fhir:Coding.code [ fhir:value "principal" ] ;
         fhir:Coding.display [ fhir:value "Principal Diagnosis" ]
       ]
     ]
  ] ;
  fhir:Claim.insurance [
     fhir:index 0 ;
     fhir:Claim.insurance.sequence [ fhir:value "1"^^xsd:positiveInteger ] ;
     fhir:Claim.insurance.focal [ fhir:value "true"^^xsd:boolean ] ;
     fhir:Claim.insurance.coverage [
       fhir:link <http://hl7.org/fhir/Coverage/COV-0001> ;
       fhir:Reference.reference [ fhir:value "Coverage/COV-0001" ]
     ]
  ] ;
  fhir:Claim.item [
     fhir:index 0 ;
     fhir:Claim.item.sequence [ fhir:value "1"^^xsd:positiveInteger ] ;
     fhir:Claim.item.careTeamSequence [
       fhir:value "1"^^xsd:positiveInteger ;
       fhir:index 0
     ] ;
     fhir:Claim.item.productOrService [
       fhir:CodeableConcept.coding [
         fhir:index 0 ;
         fhir:Coding.system [ fhir:value "https://nshr-uat.sha.go.ke/fhir/CodeSystem/KenyaSocialHealthAuthorityInterventionCS" ] ;
         fhir:Coding.code [ fhir:value "SHA-19-444" ] ;
         fhir:Coding.display [ fhir:value "Open reduction and internal fixation: Femur" ]
       ]
     ] ;
     fhir:Claim.item.quantity [
       fhir:Quantity.value [ fhir:value "1"^^xsd:decimal ]
     ] ;
     fhir:Claim.item.unitPrice [
       fhir:Money.value [ fhir:value "145600"^^xsd:decimal ] ;
       fhir:Money.currency [ fhir:value "KES" ]
     ] ;
     fhir:Claim.item.net [
       fhir:Money.value [ fhir:value "145600"^^xsd:decimal ] ;
       fhir:Money.currency [ fhir:value "KES" ]
     ]
  ] ;
  fhir:Claim.total [
     fhir:Money.value [ fhir:value "145600"^^xsd:decimal ] ;
     fhir:Money.currency [ fhir:value "KES" ]
  ] .

<http://hl7.org/fhir/Patient/PT-0001> a fhir:Patient .

<http://hl7.org/fhir/Organization/INS-001> a fhir:Organization .

<http://hl7.org/fhir/Organization/ORG-001> a fhir:Organization .

<http://hl7.org/fhir/Claim/CLAIM-0000X> a fhir:Claim .

<http://hl7.org/fhir/MedicationRequest/MED-0001> a fhir:MedicationRequest .

<http://hl7.org/fhir/ServiceRequest/SRV-0001> a fhir:ServiceRequest .

<http://hl7.org/fhir/Location/LOC-001> a fhir:Location .

<http://hl7.org/fhir/Practitioner/PRA-001> a fhir:Practitioner .

<http://hl7.org/fhir/Coverage/COV-0001> a fhir:Coverage .

# - ontology header ------------------------------------------------------------

<http://hl7.org/fhir/Claim/CR-00001.ttl> a owl:Ontology ;
  owl:imports fhir:fhir.ttl ;
  owl:versionIRI <http://build.fhir.org/Claim/CR-00001.ttl> .