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 - XML Representation

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