Kenya eClaims FHIR IG
0.1.0 - ci-build Kenya flag

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

: Example ClaimResponse - Sent Back - TTL Representation

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@prefix fhir: <http://hl7.org/fhir/> .
@prefix owl: <http://www.w3.org/2002/07/owl#> .
@prefix rdf: <http://www.w3.org/1999/02/22-rdf-syntax-ns#> .
@prefix rdfs: <http://www.w3.org/2000/01/rdf-schema#> .
@prefix xsd: <http://www.w3.org/2001/XMLSchema#> .

# - resource -------------------------------------------------------------------

 a fhir:ClaimResponse ;
  fhir:nodeRole fhir:treeRoot ;
  fhir:id [ fhir:v "8e0e3d44-4b7a-47d6-8b82-39fa646f8088"] ; # 
  fhir:meta [
    ( fhir:profile [
fhir:v "https://example.com/fhir/StructureDefinition/eClaims-claim-response"^^xsd:anyURI ;
fhir:l <https://example.com/fhir/StructureDefinition/eClaims-claim-response>     ] )
  ] ; # 
  fhir:text [
fhir:status [ fhir:v "extensions" ] ;
fhir:div [ fhir:v "<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>"^^rdf:XMLLiteral ]
  ] ; # 
  fhir:extension ( [
fhir:url [
fhir:v "https://fhir.sha.go.ke/fhir/StructureDefinition/claim-state-extension"^^xsd:anyURI ;
fhir:l <https://fhir.sha.go.ke/fhir/StructureDefinition/claim-state-extension>     ] ;
fhir:value [
a fhir:CodeableConcept ;
      ( fhir:coding [
fhir:system [
fhir:v "https://fhir.sha.go.ke/fhir/CodeSystem/claim-state"^^xsd:anyURI ;
fhir:l <https://fhir.sha.go.ke/fhir/CodeSystem/claim-state>         ] ;
fhir:code [ fhir:v "sent-back" ] ;
fhir:display [ fhir:v "Returned Back" ]       ] )     ]
  ] ) ; # 
  fhir:status [ fhir:v "active"] ; # 
  fhir:type [
    ( fhir:coding [
fhir:system [
fhir:v "http://terminology.hl7.org/CodeSystem/claim-type"^^xsd:anyURI ;
fhir:l <http://terminology.hl7.org/CodeSystem/claim-type>       ] ;
fhir:code [ fhir:v "institutional" ]     ] )
  ] ; # 
  fhir:use [ fhir:v "claim"] ; # 
  fhir:patient [
fhir:l fhir:Patient/example ;
fhir:reference [ fhir:v "Patient/example" ]
  ] ; # 
  fhir:created [ fhir:v "2025-10-07T18:47:22+00:00"^^xsd:dateTime] ; # 
  fhir:insurer [
fhir:l fhir:Organization/sha-insurer ;
fhir:reference [ fhir:v "Organization/sha-insurer" ] ;
fhir:display [ fhir:v "Social Health Authority" ]
  ] ; # 
  fhir:request [
fhir:l fhir:Claim/ae044c1d-9ecb-4294-be9b-0702e7892596 ;
fhir:reference [ fhir:v "Claim/ae044c1d-9ecb-4294-be9b-0702e7892596" ]
  ] ; # 
  fhir:outcome [ fhir:v "complete"] ; # 
  fhir:item ( [
fhir:itemSequence [ fhir:v "1"^^xsd:positiveInteger ] ;
    ( fhir:adjudication [
fhir:category [
fhir:text [ fhir:v "benefit" ]       ] ;
fhir:reason [
fhir:text [ fhir:v "Auto Approved." ]       ] ;
fhir:amount [
fhir:value [ fhir:v "11200"^^xsd:decimal ] ;
fhir:currency [ fhir:v "KES" ]       ]     ] )
  ] ) ; # 
  fhir:total ( [
fhir:category [
      ( fhir:coding [
fhir:system [
fhir:v "http://terminology.hl7.org/CodeSystem/adjudication"^^xsd:anyURI ;
fhir:l <http://terminology.hl7.org/CodeSystem/adjudication>         ] ;
fhir:code [ fhir:v "benefit" ]       ] )     ] ;
fhir:amount [
fhir:value [ fhir:v "11200"^^xsd:decimal ] ;
fhir:currency [ fhir:v "KES" ]     ]
  ] ) ; # 
  fhir:processNote ( [
fhir:number [ fhir:v "1"^^xsd:positiveInteger ] ;
fhir:type [ fhir:v "display" ] ;
fhir:text [ fhir:v "medical cases" ]
  ] [
fhir:number [ fhir:v "2"^^xsd:positiveInteger ] ;
fhir:type [ fhir:v "display" ] ;
fhir:text [ fhir:v "For surveillance review" ]
  ] ) . #