Kenya eClaims FHIR Implementation Guide
0.1.0 - ci-build
Kenya eClaims FHIR Implementation Guide
0.1.0 - ci-build
Kenya eClaims FHIR Implementation Guide, published by Digital Health Agency of 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
{
"resourceType" : "Claim",
"id" : "ECLM-SUB-001",
"meta" : {
"profile" : [
🔗 "https://nshr-uat.sha.go.ke/fhir/StructureDefinition/ke-eclaims-claimsubmission"
],
"tag" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/common-tags",
"code" : "actionable",
"display" : "Actionable"
}
]
},
"text" : {
"status" : "extensions",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p class=\"res-header-id\"><b>Generated Narrative: Claim ECLM-SUB-001</b></p><a name=\"ECLM-SUB-001\"> </a><a name=\"hcECLM-SUB-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\">Profile: <a href=\"StructureDefinition-ke-eclaims-claimsubmission.html\">Claim Submission</a></p><p style=\"margin-bottom: 0px\">Tag: <a href=\"http://hl7.org/fhir/R4/codesystem-common-tags.html\">Actionable (Details: Common Tags code actionable = 'Actionable')</a></p></div><blockquote><p><b>Patient Invoice Details</b></p><ul><li>invoiceNumber: INV-2025-00789</li><li>invoiceDate: 2025-11-22</li><li>invoiceAmount: <span title=\"Kenyan Shilling\">KES85,000.00</span> (KES)</li><li>patientShare: <span title=\"Kenyan Shilling\">KES0.00</span> (KES)</li></ul></blockquote><p><b>identifier</b>: <code>https://nshr-uat.sha.go.ke/fhir/Identifier/claim-number</code>/CLAIM-SUB-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>subType</b>: <span title=\"Codes:{https://nshr-uat.sha.go.ke/fhir/CodeSystem/claim-subtype-cs inpatient}\">Inpatient</span></p><p><b>use</b>: Claim</p><p><b>patient</b>: <a href=\"Patient-ECLM-PT-001.html\">John Mwangi Kamau (official) Male, DoB: 1985-06-15 ( National ID: 12345678\u00a0(use:\u00a0official,\u00a0))</a></p><p><b>billablePeriod</b>: 2025-11-20 --> 2025-11-22</p><p><b>created</b>: 2025-11-23 09:00:00+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 PRIMARY}\">Primary provider</span></td><td><span title=\"Codes:{https://nshr-uat.sha.go.ke/fhir/CodeSystem/eclaims-provider-qualification-cs MBChB}\">Bachelor of Medicine and Bachelor of Surgery (MBChB)</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 DC80}\">Appendicitis</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 --> 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 2}\">Surgical</span></p><p><b>productOrService</b>: <span title=\"Codes:{https://nshr-uat.sha.go.ke/fhir/CodeSystem/KenyaSocialHealthAuthorityInterventionCS SHA-19}\">Surgical Services</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>85000</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>85000</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>85000</td><td>Kenyan shilling</td></tr></table></div>"
},
"extension" : [
{
"extension" : [
{
"url" : "invoiceNumber",
"valueString" : "INV-2025-00789"
},
{
"url" : "invoiceDate",
"valueDate" : "2025-11-22"
},
{
"url" : "invoiceAmount",
"valueMoney" : {
"value" : 85000,
"currency" : "KES"
}
},
{
"url" : "patientShare",
"valueMoney" : {
"value" : 0,
"currency" : "KES"
}
}
],
"url" : "https://nshr-uat.sha.go.ke/fhir/StructureDefinition/eclaims-patient-invoice"
}
],
"identifier" : [
{
"system" : "https://nshr-uat.sha.go.ke/fhir/Identifier/claim-number",
"value" : "CLAIM-SUB-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" : "claim",
"patient" : {
🔗 "reference" : "Patient/ECLM-PT-001"
},
"billablePeriod" : {
"start" : "2025-11-20",
"end" : "2025-11-22"
},
"created" : "2025-11-23T09:00:00+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" : "MBChB",
"display" : "Bachelor of Medicine and Bachelor of Surgery (MBChB)"
}
]
}
}
],
"diagnosis" : [
{
"sequence" : 1,
"diagnosisCodeableConcept" : {
"coding" : [
{
"system" : "https://nshr-uat.sha.go.ke/fhir/CodeSystem/icd11-codes-cs",
"code" : "DC80",
"display" : "Appendicitis"
}
]
}
}
],
"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" : "2",
"display" : "Surgical"
}
]
},
"productOrService" : {
"coding" : [
{
"system" : "https://nshr-uat.sha.go.ke/fhir/CodeSystem/KenyaSocialHealthAuthorityInterventionCS",
"code" : "SHA-19",
"display" : "Surgical Services"
}
]
},
"quantity" : {
"value" : 1
},
"unitPrice" : {
"value" : 85000,
"currency" : "KES"
},
"net" : {
"value" : 85000,
"currency" : "KES"
}
}
],
"total" : {
"value" : 85000,
"currency" : "KES"
}
}