Kenya eClaims Implementation Guide
0.1.0 - ci-build
Kenya eClaims Implementation Guide
0.1.0 - ci-build
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
@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/Coverage/ECLM-COV-001> a fhir:Coverage ;
fhir:nodeRole fhir:treeRoot ;
fhir:Resource.id [ fhir:value "ECLM-COV-001"] ;
fhir:Resource.meta [
fhir:Meta.profile [
fhir:value "https://fhir.dha.go.ke/ig/eclaims/StructureDefinition/ke-eclaims-coverage" ;
fhir:index 0 ;
fhir:link <https://fhir.dha.go.ke/ig/eclaims/StructureDefinition/ke-eclaims-coverage>
], [
fhir:value "https://nshr-uat.sha.go.ke/fhir/StructureDefinition/ke-eclaims-coverage" ;
fhir:index 1 ;
fhir:link <https://nshr-uat.sha.go.ke/fhir/StructureDefinition/ke-eclaims-coverage>
] ;
fhir:Meta.tag [
fhir:index 0 ;
fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/common-tags" ] ;
fhir:Coding.code [ fhir:value "actionable" ] ;
fhir:Coding.display [ fhir:value "Actionable" ]
]
] ;
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: 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\">Profiles: <a href=\"StructureDefinition-ke-eclaims-coverage.html\">Coverage Profile</a>, <code>https://nshr-uat.sha.go.ke/fhir/StructureDefinition/ke-eclaims-coverage</code></p><p style=\"margin-bottom: 0px\">Tag: <a href=\"http://terminology.hl7.org/7.1.0/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 (use: official, ))</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 (use: official, ))</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 --> 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>"
] ;
fhir:DomainResource.extension [
fhir:index 0 ;
fhir:Extension.url [ fhir:value "https://fhir.dha.go.ke/ig/eclaims/StructureDefinition/eclaims-payment-method-extension" ] ;
fhir:Extension.valueCodeableConcept [
fhir:CodeableConcept.coding [
fhir:index 0 ;
fhir:Coding.system [ fhir:value "https://nshr-uat.sha.go.ke/fhir/CodeSystem/payment-method-cs" ] ;
fhir:Coding.code [ fhir:value "MOBILE-MONEY" ] ;
fhir:Coding.display [ fhir:value "Mobile Money" ]
]
]
], [
fhir:index 1 ;
fhir:Extension.url [ fhir:value "https://fhir.dha.go.ke/ig/eclaims/StructureDefinition/eclaims-member-status-extension" ] ;
fhir:Extension.valueCodeableConcept [
fhir:CodeableConcept.coding [
fhir:index 0 ;
fhir:Coding.system [ fhir:value "https://nshr-uat.sha.go.ke/fhir/CodeSystem/coverage-member-status-cs" ] ;
fhir:Coding.code [ fhir:value "ACTIVE" ] ;
fhir:Coding.display [ fhir:value "Active" ]
]
]
], [
fhir:index 2 ;
fhir:Extension.url [ fhir:value "https://fhir.dha.go.ke/ig/eclaims/StructureDefinition/eclaims-annual-limit-category-extension" ] ;
fhir:Extension.valueCodeableConcept [
fhir:CodeableConcept.coding [
fhir:index 0 ;
fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/service-category" ] ;
fhir:Coding.code [ fhir:value "17" ] ;
fhir:Coding.display [ fhir:value "General Practice" ]
]
]
] ;
fhir:Coverage.identifier [
fhir:index 0 ;
fhir:Identifier.system [ fhir:value "https://nshr-uat.sha.go.ke/fhir/Identifier/coverage-number" ] ;
fhir:Identifier.value [ fhir:value "COV-SHA-2024-001234" ]
] ;
fhir:Coverage.status [ fhir:value "active"] ;
fhir:Coverage.type [
fhir:CodeableConcept.coding [
fhir:index 0 ;
fhir:Coding.system [ fhir:value "https://nshr-uat.sha.go.ke/fhir/CodeSystem/coverage-type-cs" ] ;
fhir:Coding.code [ fhir:value "MEDICAL" ] ;
fhir:Coding.display [ fhir:value "Medical" ]
]
] ;
fhir:Coverage.subscriber [
fhir:link <http://hl7.org/fhir/Patient/ECLM-PT-001> ;
fhir:Reference.reference [ fhir:value "Patient/ECLM-PT-001" ]
] ;
fhir:Coverage.beneficiary [
fhir:link <http://hl7.org/fhir/Patient/ECLM-PT-001> ;
fhir:Reference.reference [ fhir:value "Patient/ECLM-PT-001" ] ;
fhir:Reference.type [ fhir:value "Patient" ]
] ;
fhir:Coverage.relationship [
fhir:CodeableConcept.coding [
fhir:index 0 ;
fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/subscriber-relationship" ] ;
fhir:Coding.code [ fhir:value "self" ] ;
fhir:Coding.display [ fhir:value "Self" ]
]
] ;
fhir:Coverage.period [
fhir:Period.start [ fhir:value "2024-01-01"^^xsd:date ] ;
fhir:Period.end [ fhir:value "2024-12-31"^^xsd:date ]
] ;
fhir:Coverage.payor [
fhir:index 0 ;
fhir:link <http://hl7.org/fhir/Organization/ECLM-INS-001> ;
fhir:Reference.reference [ fhir:value "Organization/ECLM-INS-001" ]
] ;
fhir:Coverage.class [
fhir:index 0 ;
fhir:Coverage.class.type [
fhir:CodeableConcept.coding [
fhir:index 0 ;
fhir:Coding.system [ fhir:value "https://nshr-uat.sha.go.ke/fhir/CodeSystem/coverage-class-cs" ] ;
fhir:Coding.code [ fhir:value "GROUP" ] ;
fhir:Coding.display [ fhir:value "Group" ]
]
] ;
fhir:Coverage.class.value [ fhir:value "SHA-SOCIAL-001" ] ;
fhir:Coverage.class.name [ fhir:value "SHA Social Health Scheme" ]
] .
<http://hl7.org/fhir/Patient/ECLM-PT-001> a fhir:Patient .
<http://hl7.org/fhir/Organization/ECLM-INS-001> a fhir:Organization .
# - ontology header ------------------------------------------------------------
<http://hl7.org/fhir/Coverage/ECLM-COV-001.ttl> a owl:Ontology ;
owl:imports fhir:fhir.ttl ;
owl:versionIRI <http://build.fhir.org/Coverage/ECLM-COV-001.ttl> .
IG © 2024+ Digital Health Agency (DHA), Kenya. Package ke.fhir.eclaims#0.1.0 based on FHIR 4.0.1. Generated 2026-08-07
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