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" : "ClaimResponse",
"id" : "HIEClaimResponse-example",
"meta" : {
"profile" : [
🔗 "https://nshr.dha.go.ke/fhir/StructureDefinition/hie-claimresponse"
]
},
"text" : {
"status" : "generated",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>ClaimResponse Summary</b></p><p>Outcome complete. Primary coverage approved with member copay. Payment issued.</p><table><thead><tr><th align=\"left\">Header</th><th align=\"left\">Value</th></tr></thead><tbody><tr><td>Status</td><td>active</td></tr><tr><td>Use</td><td>claim</td></tr><tr><td>Outcome</td><td>complete</td></tr><tr><td>Patient</td><td>Jane Patient</td></tr><tr><td>Insurer</td><td>Acme Health Insurance</td></tr><tr><td>Request</td><td>Claim/claim-001</td></tr><tr><td>Created</td><td>2025-11-15</td></tr></tbody></table><p><b>Item Adjudication</b></p><table><thead><tr><th align=\"left\">ItemSeq</th><th align=\"left\">Category</th><th align=\"left\">Reason</th><th align=\"left\">Amount</th></tr></thead><tbody><tr><td>1</td><td>eligible</td><td/><td>100.00 USD</td></tr><tr><td>1</td><td>copay</td><td/><td>20.00 USD</td></tr><tr><td>1</td><td>benefit</td><td/><td>80.00 USD</td></tr></tbody></table><p><b>Totals</b></p><ul><li>Submitted: 100.00 USD</li><li>Copay: 20.00 USD</li><li>Benefit: 80.00 USD</li></ul><p><b>Payment</b></p><ul><li>Type: payment</li><li>Date: 2025-11-16</li><li>Amount: 80.00 USD</li><li>Reference: EPI-778899</li></ul><p><b>Notes</b></p><ul><li>Approved per plan. Member copay applied.</li></ul></div>"
},
"identifier" : [
{
"use" : "official",
"type" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/v2-0203",
"code" : "ACSN",
"display" : "Accession ID"
}
]
},
"system" : "http://payer.example.org/claimresponses",
"value" : "CR-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"
},
"created" : "2025-11-15",
"insurer" : {
"reference" : "Organization/ins-001",
"display" : "Acme Health Insurance"
},
"requestor" : {
"reference" : "Organization/org-001",
"display" : "Acme Health Center"
},
"request" : {
"reference" : "Claim/claim-001",
"display" : "OP consult claim"
},
"outcome" : "complete",
"disposition" : "Approved per plan rules. Member copay applied.",
"preAuthRef" : "PA-556677",
"item" : [
{
"itemSequence" : 1,
"adjudication" : [
{
"category" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/adjudication",
"code" : "eligible",
"display" : "Eligible"
}
]
},
"amount" : {
"value" : 100,
"currency" : "USD"
}
},
{
"category" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/adjudication",
"code" : "copay",
"display" : "Copay"
}
]
},
"amount" : {
"value" : 20,
"currency" : "USD"
}
},
{
"category" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/adjudication",
"code" : "benefit",
"display" : "Benefit amount"
}
]
},
"amount" : {
"value" : 80,
"currency" : "USD"
}
}
],
"detail" : [
{
"detailSequence" : 1,
"adjudication" : [
{
"category" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/adjudication",
"code" : "eligible",
"display" : "Eligible"
}
]
},
"amount" : {
"value" : 100,
"currency" : "USD"
}
}
],
"subDetail" : [
{
"subDetailSequence" : 1,
"adjudication" : [
{
"category" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/adjudication",
"code" : "benefit",
"display" : "Benefit amount"
}
]
},
"amount" : {
"value" : 80,
"currency" : "USD"
}
}
]
}
]
}
]
}
],
"addItem" : [
{
"productOrService" : {
"coding" : [
{
"system" : "http://example.org/codes/payer-adjustment",
"code" : "ADJ001",
"display" : "Administrative adjustment"
}
]
},
"adjudication" : [
{
"category" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/adjudication",
"code" : "eligible",
"display" : "Eligible"
}
]
},
"amount" : {
"value" : 0,
"currency" : "USD"
}
}
]
}
],
"total" : [
{
"category" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/adjudication",
"code" : "submitted",
"display" : "Submitted Amount"
}
]
},
"amount" : {
"value" : 100,
"currency" : "USD"
}
},
{
"category" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/adjudication",
"code" : "copay",
"display" : "Copay"
}
]
},
"amount" : {
"value" : 20,
"currency" : "USD"
}
},
{
"category" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/adjudication",
"code" : "benefit",
"display" : "Benefit Amount"
}
]
},
"amount" : {
"value" : 80,
"currency" : "USD"
}
}
],
"payment" : {
"type" : {
"coding" : [
{
"system" : "http://terminology.hl7.org/CodeSystem/ex-paymenttype",
"code" : "payment",
"display" : "Payment"
}
]
},
"date" : "2025-11-16",
"amount" : {
"value" : 80,
"currency" : "USD"
},
"identifier" : {
"system" : "http://payer.example.org/erds",
"value" : "EPI-778899"
}
},
"processNote" : [
{
"number" : 1,
"type" : "display",
"text" : "Approved per plan. Member copay applied.",
"language" : {
"coding" : [
{
"system" : "urn:ietf:bcp:47",
"code" : "en",
"display" : "English"
}
]
}
}
],
"insurance" : [
{
"sequence" : 1,
"focal" : true,
"coverage" : {
"reference" : "Coverage/cov-001",
"display" : "Primary PPO coverage"
}
}
]
}