{ "resourceType" : "Claim", "id" : "ECLM-CB-001", "meta" : { "profile" : ["https://nshr-uat.sha.go.ke/fhir/StructureDefinition/ke-eclaims-claimbase"], "tag" : [{ "system" : "http://terminology.hl7.org/CodeSystem/common-tags", "code" : "actionable", "display" : "Actionable" }] }, "text" : { "status" : "generated", "div" : "

Generated Narrative: Claim ECLM-CB-001

Profile: Kenya eClaims Base Profile

Tag: Actionable (Details: Common Tags code actionable = 'Actionable')

identifier: https://nshr-uat.sha.go.ke/fhir/Identifier/claim-number/CLAIM-BASE-001

status: Active

type: Institutional

subType: Inpatient

use: Preauthorization

patient: John Mwangi Kamau (official) Male, DoB: 1985-06-15 ( National ID: 12345678\u00a0(use:\u00a0official,\u00a0))

billablePeriod: 2025-11-01 --> 2025-11-07

created: 2025-11-08 09:00:00+0300

insurer: Organization Social Health Authority

provider: Organization Nairobi General Hospital

priority: Normal

Payees

-Type
*Provider

CareTeams

-SequenceProviderRoleQualification
*1Practitioner Dr. James Ochieng (official)Primary providerDoctor of Medicine

Diagnoses

-SequenceDiagnosis[x]
*1Fracture of shaft of femur

Insurances

-SequenceFocalCoverage
*1trueCoverage: extension = Mobile Money,Active,General Practice; identifier = https://nshr-uat.sha.go.ke/fhir/Identifier/coverage-number#COV-SHA-2024-001234; status = active; type = Medical; relationship = Self; period = 2024-01-01 --> 2024-12-31

item

sequence: 1

careTeamSequence: 1

category: Medical Care

productOrService: Inpatient Services

quantity: 7

UnitPrices

-ValueCurrency
*5000Kenyan shilling

Nets

-ValueCurrency
*35000Kenyan shilling
" }, "identifier" : [{ "system" : "https://nshr-uat.sha.go.ke/fhir/Identifier/claim-number", "value" : "CLAIM-BASE-001" }], "status" : "active", "type" : { "coding" : [{ "system" : "https://nshr-uat.sha.go.ke/fhir/CodeSystem/claim-type-cs", "code" : "institutional", "display" : "Institutional" }] }, "subType" : { "coding" : [{ "system" : "https://nshr-uat.sha.go.ke/fhir/CodeSystem/claim-subtype-cs", "code" : "inpatient", "display" : "Inpatient" }] }, "use" : "preauthorization", "patient" : { "reference" : "Patient/ECLM-PT-001" }, "billablePeriod" : { "start" : "2025-11-01", "end" : "2025-11-07" }, "created" : "2025-11-08T09:00:00+03:00", "insurer" : { "reference" : "Organization/ECLM-INS-001" }, "provider" : { "reference" : "Organization/ECLM-ORG-001" }, "priority" : { "coding" : [{ "system" : "http://terminology.hl7.org/CodeSystem/processpriority", "code" : "normal", "display" : "Normal" }] }, "payee" : { "type" : { "coding" : [{ "system" : "http://terminology.hl7.org/CodeSystem/payeetype", "code" : "provider", "display" : "Provider" }] } }, "careTeam" : [{ "sequence" : 1, "provider" : { "reference" : "Practitioner/ECLM-PRA-001" }, "role" : { "coding" : [{ "system" : "https://nshr-uat.sha.go.ke/fhir/CodeSystem/claim-care-team-role-cs", "code" : "PRIMARY", "display" : "Primary provider" }] }, "qualification" : { "coding" : [{ "system" : "https://nshr-uat.sha.go.ke/fhir/CodeSystem/eclaims-provider-qualification-cs", "code" : "MD", "display" : "Doctor of Medicine" }] } }], "diagnosis" : [{ "sequence" : 1, "diagnosisCodeableConcept" : { "coding" : [{ "system" : "https://nshr-uat.sha.go.ke/fhir/CodeSystem/icd11-codes-cs", "code" : "NC72.5", "display" : "Fracture of shaft of femur" }] } }], "insurance" : [{ "sequence" : 1, "focal" : true, "coverage" : { "reference" : "Coverage/ECLM-COV-001" } }], "item" : [{ "sequence" : 1, "careTeamSequence" : [1], "category" : { "coding" : [{ "system" : "http://terminology.hl7.org/CodeSystem/ex-benefitcategory", "code" : "1", "display" : "Medical Care" }] }, "productOrService" : { "coding" : [{ "system" : "https://nshr-uat.sha.go.ke/fhir/CodeSystem/KenyaSocialHealthAuthorityInterventionCS", "code" : "SHA-07", "display" : "Inpatient Services" }] }, "quantity" : { "value" : 7 }, "unitPrice" : { "value" : 5000, "currency" : "KES" }, "net" : { "value" : 35000, "currency" : "KES" } }] }