Kenya eClaims Implementation Guide
0.1.0 - ci-build Kenya flag

Kenya eClaims Implementation Guide, published by Digital Health Agency (DHA), 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 ClaimResponse - Canceled - TTL Representation

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

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

<http://hl7.org/fhir/ClaimResponse/fd876fab-979d-4adb-8b32-46dff643b89f> a fhir:ClaimResponse ;
  fhir:nodeRole fhir:treeRoot ;
  fhir:Resource.id [ fhir:value "fd876fab-979d-4adb-8b32-46dff643b89f"] ;
  fhir:Resource.meta [
     fhir:Meta.profile [
       fhir:value "https://fhir.dha.go.ke/ig/eclaims/StructureDefinition/ke-eclaims-claimresponse" ;
       fhir:index 0 ;
       fhir:link <https://fhir.dha.go.ke/ig/eclaims/StructureDefinition/ke-eclaims-claimresponse>
     ]
  ] ;
  fhir:DomainResource.text [
     fhir:Narrative.status [ fhir:value "extensions" ] ;
     fhir:Narrative.div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p class=\"res-header-id\"><b>Generated Narrative: ClaimResponse fd876fab-979d-4adb-8b32-46dff643b89f</b></p><a name=\"fd876fab-979d-4adb-8b32-46dff643b89f\"> </a><a name=\"hcfd876fab-979d-4adb-8b32-46dff643b89f\"> </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-claimresponse.html\">Kenya eClaims ClaimResponse Profile</a></p></div><p><b>Preauthorization Expiry Date</b>: <span title=\"Codes:{https://nshr-uat.sha.go.ke/fhir/CodeSystem/claim-expiry-cs expiry-date}\">Expiry Date</span></p><p><b>Claim Workflow State</b>: <span title=\"Codes:{https://nshr-uat.sha.go.ke/fhir/CodeSystem/claim-state-cs canceled}\">Canceled</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>: Preauthorization</p><p><b>patient</b>: <a href=\"Patient-example.html\">Jane Wanjiku  Female, DoB: 1985-06-15</a></p><p><b>created</b>: 2025-10-03 07:36:24+0000</p><p><b>insurer</b>: <a href=\"Organization-sha-insurer.html\">Organization Social Health Authority</a></p><p><b>request</b>: <a href=\"Claim-a7dcd571-d8a2-483a-8a45-e3c8bcbff8b8.html\">Claim: status = active; type = Institutional; use = preauthorization; created = 2025-10-01; priority = Normal</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:{http://terminology.hl7.org/CodeSystem/adjudication benefit}\">benefit</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><p><b>value</b>: 0</p></blockquote></blockquote><blockquote><p><b>total</b></p><p><b>category</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/adjudication benefit}\">benefit</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><h3>ProcessNotes</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Number</b></td><td><b>Type</b></td><td><b>Text</b></td></tr><tr><td style=\"display: none\">*</td><td>1</td><td>Display</td><td>cancelled as requested</td></tr></table></div>"
  ] ;
  fhir:DomainResource.extension [
     fhir:index 0 ;
     fhir:Extension.url [ fhir:value "https://fhir.dha.go.ke/ig/eclaims/StructureDefinition/eclaim-expiry-extension" ] ;
     fhir:Extension.valueCodeableConcept [
       fhir:CodeableConcept.coding [
         fhir:index 0 ;
         fhir:Coding.system [ fhir:value "https://nshr-uat.sha.go.ke/fhir/CodeSystem/claim-expiry-cs" ] ;
         fhir:Coding.code [ fhir:value "expiry-date" ] ;
         fhir:Coding.display [ fhir:value "Expiry Date" ]
       ]
     ]
  ], [
     fhir:index 1 ;
     fhir:Extension.url [ fhir:value "https://fhir.dha.go.ke/ig/eclaims/StructureDefinition/eclaim-state-extension" ] ;
     fhir:Extension.valueCodeableConcept [
       fhir:CodeableConcept.coding [
         fhir:index 0 ;
         fhir:Coding.system [ fhir:value "https://nshr-uat.sha.go.ke/fhir/CodeSystem/claim-state-cs" ] ;
         fhir:Coding.code [ fhir:value "canceled" ] ;
         fhir:Coding.display [ fhir:value "Canceled" ]
       ]
     ]
  ] ;
  fhir:ClaimResponse.status [ fhir:value "active"] ;
  fhir:ClaimResponse.type [
     fhir:CodeableConcept.coding [
       fhir:index 0 ;
       fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/claim-type" ] ;
       fhir:Coding.code [ fhir:value "institutional" ]
     ]
  ] ;
  fhir:ClaimResponse.use [ fhir:value "preauthorization"] ;
  fhir:ClaimResponse.patient [
     fhir:link <http://hl7.org/fhir/Patient/example> ;
     fhir:Reference.reference [ fhir:value "Patient/example" ]
  ] ;
  fhir:ClaimResponse.created [ fhir:value "2025-10-03T07:36:24+00:00"^^xsd:dateTime] ;
  fhir:ClaimResponse.insurer [
     fhir:link <http://hl7.org/fhir/Organization/sha-insurer> ;
     fhir:Reference.reference [ fhir:value "Organization/sha-insurer" ]
  ] ;
  fhir:ClaimResponse.request [
     fhir:link <http://hl7.org/fhir/Claim/a7dcd571-d8a2-483a-8a45-e3c8bcbff8b8> ;
     fhir:Reference.reference [ fhir:value "Claim/a7dcd571-d8a2-483a-8a45-e3c8bcbff8b8" ]
  ] ;
  fhir:ClaimResponse.outcome [ fhir:value "complete"] ;
  fhir:ClaimResponse.item [
     fhir:index 0 ;
     fhir:ClaimResponse.item.itemSequence [ fhir:value "1"^^xsd:positiveInteger ] ;
     fhir:ClaimResponse.item.adjudication [
       fhir:index 0 ;
       fhir:ClaimResponse.item.adjudication.category [
         fhir:CodeableConcept.coding [
           fhir:index 0 ;
           fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/adjudication" ] ;
           fhir:Coding.code [ fhir:value "benefit" ] ;
           fhir:Coding.display [ fhir:value "Benefit Amount" ]
         ] ;
         fhir:CodeableConcept.text [ fhir:value "benefit" ]
       ] ;
       fhir:ClaimResponse.item.adjudication.amount [
         fhir:Money.value [ fhir:value "11200"^^xsd:decimal ] ;
         fhir:Money.currency [ fhir:value "KES" ]
       ] ;
       fhir:ClaimResponse.item.adjudication.value [ fhir:value "0"^^xsd:decimal ]
     ]
  ] ;
  fhir:ClaimResponse.total [
     fhir:index 0 ;
     fhir:ClaimResponse.total.category [
       fhir:CodeableConcept.coding [
         fhir:index 0 ;
         fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/adjudication" ] ;
         fhir:Coding.code [ fhir:value "benefit" ] ;
         fhir:Coding.display [ fhir:value "Benefit Amount" ]
       ] ;
       fhir:CodeableConcept.text [ fhir:value "benefit" ]
     ] ;
     fhir:ClaimResponse.total.amount [
       fhir:Money.value [ fhir:value "11200"^^xsd:decimal ] ;
       fhir:Money.currency [ fhir:value "KES" ]
     ]
  ] ;
  fhir:ClaimResponse.processNote [
     fhir:index 0 ;
     fhir:ClaimResponse.processNote.number [ fhir:value "1"^^xsd:positiveInteger ] ;
     fhir:ClaimResponse.processNote.type [ fhir:value "display" ] ;
     fhir:ClaimResponse.processNote.text [ fhir:value "cancelled as requested" ]
  ] .

<http://hl7.org/fhir/Patient/example> a fhir:Patient .

<http://hl7.org/fhir/Organization/sha-insurer> a fhir:Organization .

<http://hl7.org/fhir/Claim/a7dcd571-d8a2-483a-8a45-e3c8bcbff8b8> a fhir:Claim .

# - ontology header ------------------------------------------------------------

<http://hl7.org/fhir/ClaimResponse/fd876fab-979d-4adb-8b32-46dff643b89f.ttl> a owl:Ontology ;
  owl:imports fhir:fhir.ttl ;
  owl:versionIRI <http://build.fhir.org/ClaimResponse/fd876fab-979d-4adb-8b32-46dff643b89f.ttl> .