SIL HIE Implementation Guide
0.1.0 - sil-hie-active
SIL HIE Implementation Guide, published by Kathurima Kimathi. 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/savannahghi/hie-fhir-ig-profile/ and changes regularly. See the Directory of published versions
{
"resourceType" : "Claim",
"id" : "HIEClaim-example",
"meta" : {
"profile" : [
🔗 "https://nshr.dha.go.ke/fhir/StructureDefinition/hie-claim"
]
},
"text" : {
"status" : "generated",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>HIE Claim</b></p><p>Outpatient professional claim for Jane Patient, created 2025-11-12. Billed by Acme Health Center to PayerOne Insurance.</p><table><thead><tr><th align=\"left\">Section</th><th align=\"left\">Details</th></tr></thead><tbody><tr><td>Identifiers</td><td>Claim Number: CLM-2025-0001</td></tr><tr><td>Claim</td><td>Status: active, Use: claim, Type: professional, Priority: routine</td></tr><tr><td>Patient</td><td>Jane Patient (Patient/p-001)</td></tr><tr><td>Billable period</td><td>2025-11-10 to 2025-11-10</td></tr><tr><td>Provider</td><td>Acme Health Center (Organization/org-001)</td></tr><tr><td>Insurer</td><td>PayerOne Insurance (Organization/org-payer-001), Coverage cov-001, Focal: true</td></tr><tr><td>Diagnosis</td><td>Primary: Headache (R51.9 ICD-10-CM)</td></tr><tr><td>Items</td><td>1 x 99213, Office/outpatient visit est, UnitPrice 75.00 USD, Net 75.00 USD</td></tr><tr><td>Total</td><td>Category: submitted, Amount: 75.00 USD</td></tr></tbody></table></div>"
},
"identifier" : [
{
"use" : "official",
"type" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/v2-0203",
"code" : "ACSN",
"display" : "Accession ID"
}
]
},
"system" : "http://example.org/claims",
"value" : "CLM-2025-0001"
}
],
"status" : "active",
"type" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/claim-type",
"code" : "professional",
"display" : "Professional"
}
]
},
"use" : "claim",
"patient" : {
"reference" : "Patient/p-001",
"display" : "Jane Patient"
},
"billablePeriod" : {
"start" : "2025-11-10",
"end" : "2025-11-10"
},
"created" : "2025-11-12T10:15:00+03:00",
"insurer" : {
"reference" : "Organization/org-payer-001",
"display" : "PayerOne Insurance"
},
"provider" : {
"reference" : "Organization/org-001",
"display" : "Acme Health Center"
},
"priority" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/processpriority",
"code" : "routine",
"display" : "Routine"
}
]
},
"diagnosis" : [
{
"sequence" : 1,
"diagnosisCodeableConcept" : {
"coding" : [
{
"system" : "http://hl7.org/fhir/sid/icd-10-cm",
"code" : "R51.9",
"display" : "Headache, unspecified"
}
]
},
"type" : [
{
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/claim-diagnosis-type",
"code" : "principal",
"display" : "Principal Diagnosis"
}
]
}
]
}
],
"insurance" : [
{
"sequence" : 1,
"focal" : true,
"coverage" : {
"reference" : "Coverage/cov-001",
"display" : "Primary PPO Plan"
}
}
],
"item" : [
{
"sequence" : 1,
"revenue" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/ex-revenue-center",
"code" : "100",
"display" : "General Medical"
}
]
},
"category" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/ex-benefitcategory",
"code" : "professional-visit",
"display" : "Professional Visit"
}
]
},
"productOrService" : {
"coding" : [
{
"system" : "http://www.ama-assn.org/go/cpt",
"code" : "99213",
"display" : "Office or other outpatient visit, established patient"
}
]
},
"quantity" : {
"value" : 1
},
"unitPrice" : {
"value" : 75,
"currency" : "USD"
},
"net" : {
"value" : 75,
"currency" : "USD"
},
"encounter" : [
{
"reference" : "Encounter/enc-001",
"display" : "Ambulatory visit 2025-11-10"
}
],
"detail" : [
{
"sequence" : 1,
"productOrService" : {
"coding" : [
{
"system" : "http://www.ama-assn.org/go/cpt",
"code" : "99213",
"display" : "Office or other outpatient visit, established patient"
}
]
},
"quantity" : {
"value" : 1
},
"unitPrice" : {
"value" : 75,
"currency" : "USD"
},
"net" : {
"value" : 75,
"currency" : "USD"
},
"subDetail" : [
{
"sequence" : 1,
"productOrService" : {
"coding" : [
{
"system" : "http://www.ama-assn.org/go/cpt",
"code" : "99070",
"display" : "Supplies and materials"
}
]
},
"quantity" : {
"value" : 1
},
"unitPrice" : {
"value" : 5,
"currency" : "USD"
},
"net" : {
"value" : 5,
"currency" : "USD"
}
}
]
}
]
}
],
"total" : {
"value" : 75,
"currency" : "USD"
}
}