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 eClaims Coverage - JSON Representation

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{
  "resourceType" : "Coverage",
  "id" : "ECLM-COV-001",
  "meta" : {
    "profile" : [
      🔗 "https://nshr-uat.sha.go.ke/fhir/StructureDefinition/ke-eclaims-coverage"
    ],
    "tag" : [
      {
        "system" : "http://terminology.hl7.org/CodeSystem/common-tags",
        "code" : "actionable",
        "display" : "Actionable"
      }
    ]
  },
  "text" : {
    "status" : "extensions",
    "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p class=\"res-header-id\"><b>Generated Narrative: Coverage ECLM-COV-001</b></p><a name=\"ECLM-COV-001\"> </a><a name=\"hcECLM-COV-001\"> </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-coverage.html\">Coverage Profile</a></p><p style=\"margin-bottom: 0px\">Tag: <a href=\"http://hl7.org/fhir/R4/codesystem-common-tags.html\">Actionable (Details: Common Tags code actionable = 'Actionable')</a></p></div><p><b>Paymen tMethod Extension</b>: <span title=\"Codes:{https://nshr-uat.sha.go.ke/fhir/CodeSystem/payment-method-cs MOBILE-MONEY}\">Mobile Money</span></p><p><b>Current member status Extension</b>: <span title=\"Codes:{https://nshr-uat.sha.go.ke/fhir/CodeSystem/coverage-member-status-cs ACTIVE}\">Active</span></p><p><b>Annual Limits Category Extension</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/service-category 17}\">General Practice</span></p><p><b>identifier</b>: <code>https://nshr-uat.sha.go.ke/fhir/Identifier/coverage-number</code>/COV-SHA-2024-001234</p><p><b>status</b>: Active</p><p><b>type</b>: <span title=\"Codes:{https://nshr-uat.sha.go.ke/fhir/CodeSystem/coverage-type-cs MEDICAL}\">Medical</span></p><p><b>subscriber</b>: <a href=\"Patient-ECLM-PT-001.html\">John Mwangi Kamau (official) Male, DoB: 1985-06-15 ( National ID: 12345678\u00a0(use:\u00a0official,\u00a0))</a></p><p><b>beneficiary</b>: <a href=\"Patient-ECLM-PT-001.html\">John Mwangi Kamau (official) Male, DoB: 1985-06-15 ( National ID: 12345678\u00a0(use:\u00a0official,\u00a0))</a></p><p><b>relationship</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/subscriber-relationship self}\">Self</span></p><p><b>period</b>: 2024-01-01 --&gt; 2024-12-31</p><p><b>payor</b>: <a href=\"Organization-ECLM-INS-001.html\">Organization Social Health Authority</a></p><h3>Classes</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Type</b></td><td><b>Value</b></td><td><b>Name</b></td></tr><tr><td style=\"display: none\">*</td><td><span title=\"Codes:{https://nshr-uat.sha.go.ke/fhir/CodeSystem/coverage-class-cs GROUP}\">Group</span></td><td>SHA-SOCIAL-001</td><td>SHA Social Health Scheme</td></tr></table></div>"
  },
  "extension" : [
    {
      "url" : "https://nshr-uat.sha.go.ke/fhir/StructureDefinition/eclaims-payment-method-extension",
      "valueCodeableConcept" : {
        "coding" : [
          {
            "system" : "https://nshr-uat.sha.go.ke/fhir/CodeSystem/payment-method-cs",
            "code" : "MOBILE-MONEY",
            "display" : "Mobile Money"
          }
        ]
      }
    },
    {
      "url" : "https://nshr-uat.sha.go.ke/fhir/StructureDefinition/eclaims-member-status-extension",
      "valueCodeableConcept" : {
        "coding" : [
          {
            "system" : "https://nshr-uat.sha.go.ke/fhir/CodeSystem/coverage-member-status-cs",
            "code" : "ACTIVE",
            "display" : "Active"
          }
        ]
      }
    },
    {
      "url" : "https://nshr-uat.sha.go.ke/fhir/StructureDefinition/eclaims-annual-limit-category-extension",
      "valueCodeableConcept" : {
        "coding" : [
          {
            "system" : "http://terminology.hl7.org/CodeSystem/service-category",
            "code" : "17",
            "display" : "General Practice"
          }
        ]
      }
    }
  ],
  "identifier" : [
    {
      "system" : "https://nshr-uat.sha.go.ke/fhir/Identifier/coverage-number",
      "value" : "COV-SHA-2024-001234"
    }
  ],
  "status" : "active",
  "type" : {
    "coding" : [
      {
        "system" : "https://nshr-uat.sha.go.ke/fhir/CodeSystem/coverage-type-cs",
        "code" : "MEDICAL",
        "display" : "Medical"
      }
    ]
  },
  "subscriber" : {
    🔗 "reference" : "Patient/ECLM-PT-001"
  },
  "beneficiary" : {
    🔗 "reference" : "Patient/ECLM-PT-001",
    "type" : "Patient"
  },
  "relationship" : {
    "coding" : [
      {
        "system" : "http://terminology.hl7.org/CodeSystem/subscriber-relationship",
        "code" : "self",
        "display" : "Self"
      }
    ]
  },
  "period" : {
    "start" : "2024-01-01",
    "end" : "2024-12-31"
  },
  "payor" : [
    {
      🔗 "reference" : "Organization/ECLM-INS-001"
    }
  ],
  "class" : [
    {
      "type" : {
        "coding" : [
          {
            "system" : "https://nshr-uat.sha.go.ke/fhir/CodeSystem/coverage-class-cs",
            "code" : "GROUP",
            "display" : "Group"
          }
        ]
      },
      "value" : "SHA-SOCIAL-001",
      "name" : "SHA Social Health Scheme"
    }
  ]
}