Kenya eClaims FHIR Implementation Guide
0.1.0 - ci-build Kenya flag

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

Example Claim: Example Surgical Preauthorization

Anaesthesia Type: General

Chief Complaint: Acute right iliac fossa pain, nausea, low-grade fever for 24 hours

Clinical Indications: Acute appendicitis confirmed on clinical examination and USS

Vital Signs: Temp: 38.2°C; BP: 118/76 mmHg; HR: 96 bpm

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

status: Active

type: Institutional

use: Preauthorization

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

billablePeriod: 2025-11-20 --> 2025-11-22

created: 2025-11-19 18:00:00+0300

insurer: Organization Social Health Authority

provider: Organization Nairobi General Hospital

priority: Immediate

Payees

-Type
*Provider

CareTeams

-SequenceProviderRoleQualification
*1Practitioner Dr. James Ochieng (official)Primary providerBachelor of Medicine and Bachelor of Surgery (MBChB)

Diagnoses

-SequenceDiagnosis[x]
*1Appendicitis

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: Surgical

productOrService: Surgical Services

quantity: 1

UnitPrices

-ValueCurrency
*85000Kenyan shilling

Nets

-ValueCurrency
*85000Kenyan shilling