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 - XML Representation

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<Coverage xmlns="http://hl7.org/fhir">
  <id value="ECLM-COV-001"/>
  <meta>
    <profile
             value="https://nshr-uat.sha.go.ke/fhir/StructureDefinition/ke-eclaims-coverage"/>
    <tag>
      <system value="http://terminology.hl7.org/CodeSystem/common-tags"/>
      <code value="actionable"/>
      <display value="Actionable"/>
    </tag>
  </meta>
  <text>
    <status value="extensions"/>
    <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 (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 --&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>
  </text>
  <extension
             url="https://nshr-uat.sha.go.ke/fhir/StructureDefinition/eclaims-payment-method-extension">
    <valueCodeableConcept>
      <coding>
        <system
                value="https://nshr-uat.sha.go.ke/fhir/CodeSystem/payment-method-cs"/>
        <code value="MOBILE-MONEY"/>
        <display value="Mobile Money"/>
      </coding>
    </valueCodeableConcept>
  </extension>
  <extension
             url="https://nshr-uat.sha.go.ke/fhir/StructureDefinition/eclaims-member-status-extension">
    <valueCodeableConcept>
      <coding>
        <system
                value="https://nshr-uat.sha.go.ke/fhir/CodeSystem/coverage-member-status-cs"/>
        <code value="ACTIVE"/>
        <display value="Active"/>
      </coding>
    </valueCodeableConcept>
  </extension>
  <extension
             url="https://nshr-uat.sha.go.ke/fhir/StructureDefinition/eclaims-annual-limit-category-extension">
    <valueCodeableConcept>
      <coding>
        <system
                value="http://terminology.hl7.org/CodeSystem/service-category"/>
        <code value="17"/>
        <display value="General Practice"/>
      </coding>
    </valueCodeableConcept>
  </extension>
  <identifier>
    <system
            value="https://nshr-uat.sha.go.ke/fhir/Identifier/coverage-number"/>
    <value value="COV-SHA-2024-001234"/>
  </identifier>
  <status value="active"/>
  <type>
    <coding>
      <system
              value="https://nshr-uat.sha.go.ke/fhir/CodeSystem/coverage-type-cs"/>
      <code value="MEDICAL"/>
      <display value="Medical"/>
    </coding>
  </type>
  <subscriber>🔗 
    <reference value="Patient/ECLM-PT-001"/>
  </subscriber>
  <beneficiary>🔗 
    <reference value="Patient/ECLM-PT-001"/>
    <type value="Patient"/>
  </beneficiary>
  <relationship>
    <coding>
      <system
              value="http://terminology.hl7.org/CodeSystem/subscriber-relationship"/>
      <code value="self"/>
      <display value="Self"/>
    </coding>
  </relationship>
  <period>
    <start value="2024-01-01"/>
    <end value="2024-12-31"/>
  </period>
  <payor>🔗 
    <reference value="Organization/ECLM-INS-001"/>
  </payor>
  <class>
    <type>
      <coding>
        <system
                value="https://nshr-uat.sha.go.ke/fhir/CodeSystem/coverage-class-cs"/>
        <code value="GROUP"/>
        <display value="Group"/>
      </coding>
    </type>
    <value value="SHA-SOCIAL-001"/>
    <name value="SHA Social Health Scheme"/>
  </class>
</Coverage>