Example Imaging Preauthorization - 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 Imaging Preauthorization - 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/ECLM-IMG-001> a fhir:Claim ;
  fhir:nodeRole fhir:treeRoot ;
  fhir:Resource.id [ fhir:value "ECLM-IMG-001"] ;
  fhir:Resource.meta [
     fhir:Meta.profile [
       fhir:value "https://fhir.dha.go.ke/ig/eclaims/StructureDefinition/ke-eclaims-imagingpreauth" ;
       fhir:index 0 ;
       fhir:link <https://fhir.dha.go.ke/ig/eclaims/StructureDefinition/ke-eclaims-imagingpreauth>
     ], [
       fhir:value "https://nshr-uat.sha.go.ke/fhir/StructureDefinition/ke-eclaims-imagingpreauth" ;
       fhir:index 1 ;
       fhir:link <https://nshr-uat.sha.go.ke/fhir/StructureDefinition/ke-eclaims-imagingpreauth>
     ] ;
     fhir:Meta.tag [
       fhir:index 0 ;
       fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/common-tags" ] ;
       fhir:Coding.code [ fhir:value "actionable" ] ;
       fhir:Coding.display [ fhir:value "Actionable" ]
     ]
  ] ;
  fhir:DomainResource.text [
     fhir:Narrative.status [ fhir:value "extensions" ] ;
     fhir:Narrative.div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p class=\"res-header-id\"><b>Generated Narrative: Claim ECLM-IMG-001</b></p><a name=\"ECLM-IMG-001\"> </a><a name=\"hcECLM-IMG-001\"> </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-imagingpreauth.html\">Imaging Preauthorization</a>, <code>https://nshr-uat.sha.go.ke/fhir/StructureDefinition/ke-eclaims-imagingpreauth</code></p><p style=\"margin-bottom: 0px\">Tag: <a href=\"http://terminology.hl7.org/7.1.0/CodeSystem-common-tags.html\">Actionable (Details: Common Tags code actionable = 'Actionable')</a></p></div><p><b>Clinical Indications</b>: Suspected fracture of right femur shaft following road traffic accident</p><p><b>Investigations</b>: MRI right femur — plain and contrast</p><p><b>identifier</b>: <code>https://nshr-uat.sha.go.ke/fhir/Identifier/claim-number</code>/CLAIM-IMG-001</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>use</b>: Preauthorization</p><p><b>patient</b>: <a href=\"Patient-ECLM-PT-001.html\">John Mwangi Kamau (official) Male, DoB: 1985-06-15 ( National ID: 12345678 (use: official, ))</a></p><p><b>billablePeriod</b>: 2025-11-05 --&gt; 2025-11-05</p><p><b>created</b>: 2025-11-05 10:00:00+0300</p><p><b>insurer</b>: <a href=\"Organization-ECLM-INS-001.html\">Organization Social Health Authority</a></p><p><b>provider</b>: <a href=\"Organization-ECLM-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>Payees</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Type</b></td></tr><tr><td style=\"display: none\">*</td><td><span title=\"Codes:{http://terminology.hl7.org/CodeSystem/payeetype provider}\">Provider</span></td></tr></table><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-ECLM-PRA-001.html\">Practitioner Dr. James Ochieng (official)</a></td><td><span title=\"Codes:{https://nshr-uat.sha.go.ke/fhir/CodeSystem/claim-care-team-role-cs ORDERING}\">Ordering 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>Diagnoses</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Sequence</b></td><td><b>Diagnosis[x]</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></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-ECLM-COV-001.html\">Coverage: 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 --&gt; 2024-12-31</a></td></tr></table><blockquote><p><b>item</b></p><p><b>sequence</b>: 1</p><p><b>careTeamSequence</b>: 1</p><p><b>category</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/ex-benefitcategory 1}\">Medical Care</span></p><p><b>productOrService</b>: <span title=\"Codes:{https://nshr-uat.sha.go.ke/fhir/CodeSystem/KenyaSocialHealthAuthorityInterventionCS SHA-09}\">Medical Imaging</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>18500</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>18500</td><td>Kenyan shilling</td></tr></table></blockquote></div>"
  ] ;
  fhir:DomainResource.extension [
     fhir:index 0 ;
     fhir:Extension.url [ fhir:value "https://fhir.dha.go.ke/ig/eclaims/StructureDefinition/eclaims-clinical-indications" ] ;
     fhir:Extension.valueString [ fhir:value "Suspected fracture of right femur shaft following road traffic accident" ]
  ], [
     fhir:index 1 ;
     fhir:Extension.url [ fhir:value "https://fhir.dha.go.ke/ig/eclaims/StructureDefinition/eclaims-investigations" ] ;
     fhir:Extension.valueString [ fhir:value "MRI right femur — plain and contrast" ]
  ] ;
  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-IMG-001" ]
  ] ;
  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.use [ fhir:value "preauthorization"] ;
  fhir:Claim.patient [
     fhir:link <http://hl7.org/fhir/Patient/ECLM-PT-001> ;
     fhir:Reference.reference [ fhir:value "Patient/ECLM-PT-001" ]
  ] ;
  fhir:Claim.billablePeriod [
     fhir:Period.start [ fhir:value "2025-11-05"^^xsd:date ] ;
     fhir:Period.end [ fhir:value "2025-11-05"^^xsd:date ]
  ] ;
  fhir:Claim.created [ fhir:value "2025-11-05T10:00:00+03:00"^^xsd:dateTime] ;
  fhir:Claim.insurer [
     fhir:link <http://hl7.org/fhir/Organization/ECLM-INS-001> ;
     fhir:Reference.reference [ fhir:value "Organization/ECLM-INS-001" ]
  ] ;
  fhir:Claim.provider [
     fhir:link <http://hl7.org/fhir/Organization/ECLM-ORG-001> ;
     fhir:Reference.reference [ fhir:value "Organization/ECLM-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.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.careTeam [
     fhir:index 0 ;
     fhir:Claim.careTeam.sequence [ fhir:value "1"^^xsd:positiveInteger ] ;
     fhir:Claim.careTeam.provider [
       fhir:link <http://hl7.org/fhir/Practitioner/ECLM-PRA-001> ;
       fhir:Reference.reference [ fhir:value "Practitioner/ECLM-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 "ORDERING" ] ;
         fhir:Coding.display [ fhir:value "Ordering 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.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.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/ECLM-COV-001> ;
       fhir:Reference.reference [ fhir:value "Coverage/ECLM-COV-001" ]
     ]
  ] ;
  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.category [
       fhir:CodeableConcept.coding [
         fhir:index 0 ;
         fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/ex-benefitcategory" ] ;
         fhir:Coding.code [ fhir:value "1" ] ;
         fhir:Coding.display [ fhir:value "Medical Care" ]
       ]
     ] ;
     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-09" ] ;
         fhir:Coding.display [ fhir:value "Medical Imaging" ]
       ]
     ] ;
     fhir:Claim.item.quantity [
       fhir:Quantity.value [ fhir:value "1"^^xsd:decimal ]
     ] ;
     fhir:Claim.item.unitPrice [
       fhir:Money.value [ fhir:value "18500"^^xsd:decimal ] ;
       fhir:Money.currency [ fhir:value "KES" ]
     ] ;
     fhir:Claim.item.net [
       fhir:Money.value [ fhir:value "18500"^^xsd:decimal ] ;
       fhir:Money.currency [ fhir:value "KES" ]
     ]
  ] .

<http://hl7.org/fhir/Patient/ECLM-PT-001> a fhir:Patient .

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

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

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

<http://hl7.org/fhir/Coverage/ECLM-COV-001> a fhir:Coverage .

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

<http://hl7.org/fhir/Claim/ECLM-IMG-001.ttl> a owl:Ontology ;
  owl:imports fhir:fhir.ttl ;
  owl:versionIRI <http://build.fhir.org/Claim/ECLM-IMG-001.ttl> .