Kenya eClaims FHIR IG, published by iclKenya. 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

• Narrative Content
• XML
• JSON
• TTL

: Example ClaimResponse - Sent Back - JSON Representation

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{
  "resourceType" : "ClaimResponse",
  "id" : "8e0e3d44-4b7a-47d6-8b82-39fa646f8088",
  "meta" : {
    "profile" : [
      🔗 "https://example.com/fhir/StructureDefinition/eClaims-claim-response"
    ]
  },
  "text" : {
    "status" : "extensions",
    "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p class=\"res-header-id\"><b>Generated Narrative: ClaimResponse 8e0e3d44-4b7a-47d6-8b82-39fa646f8088</b></p><a name=\"8e0e3d44-4b7a-47d6-8b82-39fa646f8088\"> </a><a name=\"hc8e0e3d44-4b7a-47d6-8b82-39fa646f8088\"> </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-eClaims-claim-response.html\">Kenya eClaims ClaimResponse Profile</a></p></div><p><b>Claim Workflow State</b>: <span title=\"Codes:{https://fhir.sha.go.ke/fhir/CodeSystem/claim-state sent-back}\">Returned Back</span></p><p><b>status</b>: Active</p><p><b>type</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/claim-type institutional}\">Institutional</span></p><p><b>use</b>: Claim</p><p><b>patient</b>: <a href=\"Patient/example\">Patient/example</a></p><p><b>created</b>: 2025-10-07 18:47:22+0000</p><p><b>insurer</b>: <a href=\"Organization/sha-insurer\">Social Health Authority</a></p><p><b>request</b>: <a href=\"Claim/ae044c1d-9ecb-4294-be9b-0702e7892596\">Claim/ae044c1d-9ecb-4294-be9b-0702e7892596</a></p><p><b>outcome</b>: Processing Complete</p><blockquote><p><b>item</b></p><p><b>itemSequence</b>: 1</p><blockquote><p><b>adjudication</b></p><p><b>category</b>: <span title=\"Codes:\">benefit</span></p><p><b>reason</b>: <span title=\"Codes:\">Auto Approved.</span></p><h3>Amounts</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>11200</td><td>Kenyan shilling</td></tr></table></blockquote></blockquote><blockquote><p><b>total</b></p><p><b>category</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/adjudication benefit}\">Benefit Amount</span></p><h3>Amounts</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>11200</td><td>Kenyan shilling</td></tr></table></blockquote><blockquote><p><b>processNote</b></p><p><b>number</b>: 1</p><p><b>type</b>: Display</p><p><b>text</b>: medical cases</p></blockquote><blockquote><p><b>processNote</b></p><p><b>number</b>: 2</p><p><b>type</b>: Display</p><p><b>text</b>: For surveillance review</p></blockquote></div>"
  },
  "extension" : [
    {
      "url" : "https://fhir.sha.go.ke/fhir/StructureDefinition/claim-state-extension",
      "valueCodeableConcept" : {
        "coding" : [
          {
            "system" : "https://fhir.sha.go.ke/fhir/CodeSystem/claim-state",
            "code" : "sent-back",
            "display" : "Returned Back"
          }
        ]
      }
    }
  ],
  "status" : "active",
  "type" : {
    "coding" : [
      {
        "system" : "http://terminology.hl7.org/CodeSystem/claim-type",
        "code" : "institutional"
      }
    ]
  },
  "use" : "claim",
  "patient" : {
    "reference" : "Patient/example"
  },
  "created" : "2025-10-07T18:47:22+00:00",
  "insurer" : {
    "reference" : "Organization/sha-insurer",
    "display" : "Social Health Authority"
  },
  "request" : {
    "reference" : "Claim/ae044c1d-9ecb-4294-be9b-0702e7892596"
  },
  "outcome" : "complete",
  "item" : [
    {
      "itemSequence" : 1,
      "adjudication" : [
        {
          "category" : {
            "text" : "benefit"
          },
          "reason" : {
            "text" : "Auto Approved."
          },
          "amount" : {
            "value" : 11200,
            "currency" : "KES"
          }
        }
      ]
    }
  ],
  "total" : [
    {
      "category" : {
        "coding" : [
          {
            "system" : "http://terminology.hl7.org/CodeSystem/adjudication",
            "code" : "benefit"
          }
        ]
      },
      "amount" : {
        "value" : 11200,
        "currency" : "KES"
      }
    }
  ],
  "processNote" : [
    {
      "number" : 1,
      "type" : "display",
      "text" : "medical cases"
    },
    {
      "number" : 2,
      "type" : "display",
      "text" : "For surveillance review"
    }
  ]
}