ECLM-REN-001
type: Claim
node role: treeRoot
resource.id:
  value: ECLM-REN-001
resource.meta:
  meta.profile:
    value: https://fhir.dha.go.ke/ig/eclaims/StructureDefinition/ke-eclaims-renalpreauth
    index: 0
    link: https://fhir.dha.go.ke/ig/eclaims/StructureDefinition/ke-eclaims-renalpreauth
  meta.profile:
    value: https://nshr-uat.sha.go.ke/fhir/StructureDefinition/ke-eclaims-renalpreauth
    index: 1
    link: https://nshr-uat.sha.go.ke/fhir/StructureDefinition/ke-eclaims-renalpreauth
  meta.tag:
    index: 0
    coding.system:
      value: http://terminology.hl7.org/CodeSystem/common-tags
    coding.code:
      value: actionable
    coding.display:
      value: Actionable
domain resource.text:
  narrative.status:
    value: extensions
  narrative.div: Generated Narrative: Claim ECLM-REN-001 Profiles: Renal Preauthorization, https://nshr-uat.sha.go.ke/fhir/StructureDefinition/ke-eclaims-renalpreauth Tag: Actionable (Details: Common Tags code actionable = 'Actionable') Session Expected Date: 2025-12-01 Clinical Indications: End Stage Renal Disease (ESRD) — chronic haemodialysis programme Vital Signs: BP: 148/92 mmHg; Weight: 68 kg; Temp: 36.8°C identifier: https://nshr-uat.sha.go.ke/fhir/Identifier/claim-number/CLAIM-REN-001 status: Active type: Institutional use: Preauthorization patient: John Mwangi Kamau (official) Male, DoB: 1985-06-15 ( National ID: 12345678 (use: official, )) billablePeriod: 2025-12-01 --> 2025-12-01 created: 2025-11-28 08:00:00+0300 insurer: Organization Social Health Authority provider: Organization Nairobi General Hospital priority: Normal Payees - Type * Provider CareTeams - Sequence Provider Role Qualification * 1 Practitioner Dr. James Ochieng (official) Primary provider Doctor of Medicine Diagnoses - Sequence Diagnosis[x] * 1 Chronic kidney disease Insurances - Sequence Focal Coverage * 1 true 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 --> 2024-12-31 item sequence: 1 careTeamSequence: 1 category: Medical Care productOrService: Renal Care Services quantity: 1 UnitPrices - Value Currency * 12500 Kenyan shilling Nets - Value Currency * 12500 Kenyan shilling
domain resource.extension:
  index: 0
  extension.url:
    value: https://fhir.dha.go.ke/ig/eclaims/StructureDefinition/eclaims-session-expected-date
  extension.value string:
    value: 2025-12-01
domain resource.extension:
  index: 1
  extension.url:
    value: https://fhir.dha.go.ke/ig/eclaims/StructureDefinition/eclaims-clinical-indications
  extension.value string:
    value: End Stage Renal Disease (ESRD) — chronic haemodialysis programme
domain resource.extension:
  index: 2
  extension.url:
    value: https://fhir.dha.go.ke/ig/eclaims/StructureDefinition/eclaims-vital-signs
  extension.value string:
    value: BP: 148/92 mmHg; Weight: 68 kg; Temp: 36.8°C
claim.identifier:
  index: 0
  identifier.system:
    value: https://nshr-uat.sha.go.ke/fhir/Identifier/claim-number
  identifier.value:
    value: CLAIM-REN-001
claim.status:
  value: active
claim.type:
  codeable concept.coding:
    index: 0
    coding.system:
      value: https://nshr-uat.sha.go.ke/fhir/CodeSystem/claim-type-cs
    coding.code:
      value: institutional
    coding.display:
      value: Institutional
claim.use:
  value: preauthorization
claim.patient:
  link: https://fhir.dha.go.ke/ig/eclaims/Patient/ECLM-PT-001
  reference.reference:
    value: Patient/ECLM-PT-001
claim.billable period:
  period.start:
    value: 2025-12-01
  period.end:
    value: 2025-12-01
claim.created:
  value: 2025-11-28T08:00:00+03:00
claim.insurer:
  link: https://fhir.dha.go.ke/ig/eclaims/Organization/ECLM-INS-001
  reference.reference:
    value: Organization/ECLM-INS-001
claim.provider:
  link: https://fhir.dha.go.ke/ig/eclaims/Organization/ECLM-ORG-001
  reference.reference:
    value: Organization/ECLM-ORG-001
claim.priority:
  codeable concept.coding:
    index: 0
    coding.system:
      value: http://terminology.hl7.org/CodeSystem/processpriority
    coding.code:
      value: normal
    coding.display:
      value: Normal
claim.payee:
  claim.payee.type:
    codeable concept.coding:
      index: 0
      coding.system:
        value: http://terminology.hl7.org/CodeSystem/payeetype
      coding.code:
        value: provider
      coding.display:
        value: Provider
claim.care team:
  index: 0
  claim.care team.sequence:
    value: 1
  claim.care team.provider:
    link: https://fhir.dha.go.ke/ig/eclaims/Practitioner/ECLM-PRA-001
    reference.reference:
      value: Practitioner/ECLM-PRA-001
  claim.care team.role:
    codeable concept.coding:
      index: 0
      coding.system:
        value: https://nshr-uat.sha.go.ke/fhir/CodeSystem/claim-care-team-role-cs
      coding.code:
        value: PRIMARY
      coding.display:
        value: Primary provider
  claim.care team.qualification:
    codeable concept.coding:
      index: 0
      coding.system:
        value: https://nshr-uat.sha.go.ke/fhir/CodeSystem/eclaims-provider-qualification-cs
      coding.code:
        value: MD
      coding.display:
        value: Doctor of Medicine
claim.diagnosis:
  index: 0
  claim.diagnosis.sequence:
    value: 1
  claim.diagnosis.diagnosis codeable concept:
    codeable concept.coding:
      index: 0
      coding.system:
        value: https://nshr-uat.sha.go.ke/fhir/CodeSystem/icd11-codes-cs
      coding.code:
        value: GB61
      coding.display:
        value: Chronic kidney disease
claim.insurance:
  index: 0
  claim.insurance.sequence:
    value: 1
  claim.insurance.focal:
    value: true
  claim.insurance.coverage:
    link: https://fhir.dha.go.ke/ig/eclaims/Coverage/ECLM-COV-001
    reference.reference:
      value: Coverage/ECLM-COV-001
claim.item:
  index: 0
  claim.item.sequence:
    value: 1
  claim.item.care team sequence:
    value: 1
    index: 0
  claim.item.category:
    codeable concept.coding:
      index: 0
      coding.system:
        value: http://terminology.hl7.org/CodeSystem/ex-benefitcategory
      coding.code:
        value: 1
      coding.display:
        value: Medical Care
  claim.item.product or service:
    codeable concept.coding:
      index: 0
      coding.system:
        value: https://nshr-uat.sha.go.ke/fhir/CodeSystem/KenyaSocialHealthAuthorityInterventionCS
      coding.code:
        value: SHA-16
      coding.display:
        value: Renal Care Services
  claim.item.quantity:
    quantity.value:
      value: 1
  claim.item.unit price:
    money.value:
      value: 12500
    money.currency:
      value: KES
  claim.item.net:
    money.value:
      value: 12500
    money.currency:
      value: KES