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

• Narrative Content
• XML
• JSON
• TTL

: Example HIE Claim - XML Representation

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<Claim xmlns="http://hl7.org/fhir">
  <id value="HIEClaim-example"/>
  <meta>
    <profile
             value="https://nshr.dha.go.ke/fhir/StructureDefinition/hie-claim"/>
  </meta>
  <text>
    <status value="generated"/>
    <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>
  </text>
  <identifier>
    <use value="official"/>
    <type>
      <coding>
        <system value="http://terminology.hl7.org/CodeSystem/v2-0203"/>
        <code value="ACSN"/>
        <display value="Accession ID"/>
      </coding>
    </type>
    <system value="http://example.org/claims"/>
    <value value="CLM-2025-0001"/>
  </identifier>
  <status value="active"/>
  <type>
    <coding>
      <system value="http://terminology.hl7.org/CodeSystem/claim-type"/>
      <code value="professional"/>
      <display value="Professional"/>
    </coding>
  </type>
  <use value="claim"/>
  <patient>
    <reference value="Patient/p-001"/>
    <display value="Jane Patient"/>
  </patient>
  <billablePeriod>
    <start value="2025-11-10"/>
    <end value="2025-11-10"/>
  </billablePeriod>
  <created value="2025-11-12T10:15:00+03:00"/>
  <insurer>
    <reference value="Organization/org-payer-001"/>
    <display value="PayerOne Insurance"/>
  </insurer>
  <provider>
    <reference value="Organization/org-001"/>
    <display value="Acme Health Center"/>
  </provider>
  <priority>
    <coding>
      <system value="http://terminology.hl7.org/CodeSystem/processpriority"/>
      <code value="routine"/>
      <display value="Routine"/>
    </coding>
  </priority>
  <diagnosis>
    <sequence value="1"/>
    <diagnosisCodeableConcept>
      <coding>
        <system value="http://hl7.org/fhir/sid/icd-10-cm"/>
        <code value="R51.9"/>
        <display value="Headache, unspecified"/>
      </coding>
    </diagnosisCodeableConcept>
    <type>
      <coding>
        <system
                value="http://terminology.hl7.org/CodeSystem/claim-diagnosis-type"/>
        <code value="principal"/>
        <display value="Principal Diagnosis"/>
      </coding>
    </type>
  </diagnosis>
  <insurance>
    <sequence value="1"/>
    <focal value="true"/>
    <coverage>
      <reference value="Coverage/cov-001"/>
      <display value="Primary PPO Plan"/>
    </coverage>
  </insurance>
  <item>
    <sequence value="1"/>
    <revenue>
      <coding>
        <system
                value="http://terminology.hl7.org/CodeSystem/ex-revenue-center"/>
        <code value="100"/>
        <display value="General Medical"/>
      </coding>
    </revenue>
    <category>
      <coding>
        <system
                value="http://terminology.hl7.org/CodeSystem/ex-benefitcategory"/>
        <code value="professional-visit"/>
        <display value="Professional Visit"/>
      </coding>
    </category>
    <productOrService>
      <coding>
        <system value="http://www.ama-assn.org/go/cpt"/>
        <code value="99213"/>
        <display
                 value="Office or other outpatient visit, established patient"/>
      </coding>
    </productOrService>
    <quantity>
      <value value="1"/>
    </quantity>
    <unitPrice>
      <value value="75"/>
      <currency value="USD"/>
    </unitPrice>
    <net>
      <value value="75"/>
      <currency value="USD"/>
    </net>
    <encounter>
      <reference value="Encounter/enc-001"/>
      <display value="Ambulatory visit 2025-11-10"/>
    </encounter>
    <detail>
      <sequence value="1"/>
      <productOrService>
        <coding>
          <system value="http://www.ama-assn.org/go/cpt"/>
          <code value="99213"/>
          <display
                   value="Office or other outpatient visit, established patient"/>
        </coding>
      </productOrService>
      <quantity>
        <value value="1"/>
      </quantity>
      <unitPrice>
        <value value="75"/>
        <currency value="USD"/>
      </unitPrice>
      <net>
        <value value="75"/>
        <currency value="USD"/>
      </net>
      <subDetail>
        <sequence value="1"/>
        <productOrService>
          <coding>
            <system value="http://www.ama-assn.org/go/cpt"/>
            <code value="99070"/>
            <display value="Supplies and materials"/>
          </coding>
        </productOrService>
        <quantity>
          <value value="1"/>
        </quantity>
        <unitPrice>
          <value value="5"/>
          <currency value="USD"/>
        </unitPrice>
        <net>
          <value value="5"/>
          <currency value="USD"/>
        </net>
      </subDetail>
    </detail>
  </item>
  <total>
    <value value="75"/>
    <currency value="USD"/>
  </total>
</Claim>