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
@prefix fhir: <http://hl7.org/fhir/> .
@prefix owl: <http://www.w3.org/2002/07/owl#> .
@prefix rdf: <http://www.w3.org/1999/02/22-rdf-syntax-ns#> .
@prefix rdfs: <http://www.w3.org/2000/01/rdf-schema#> .
@prefix xsd: <http://www.w3.org/2001/XMLSchema#> .
# - resource -------------------------------------------------------------------
a fhir:ClaimResponse ;
fhir:nodeRole fhir:treeRoot ;
fhir:id [ fhir:v "HIEClaimResponse-example"] ; #
fhir:meta [
( fhir:profile [
fhir:v "https://nshr.dha.go.ke/fhir/StructureDefinition/hie-claimresponse"^^xsd:anyURI ;
fhir:l <https://nshr.dha.go.ke/fhir/StructureDefinition/hie-claimresponse> ] )
] ; #
fhir:text [
fhir:status [ fhir:v "generated" ] ;
fhir:div [ fhir:v "<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>"^^rdf:XMLLiteral ]
] ; #
fhir:identifier ( [
fhir:use [ fhir:v "official" ] ;
fhir:type [
( fhir:coding [
fhir:system [
fhir:v "http://terminology.hl7.org/CodeSystem/v2-0203"^^xsd:anyURI ;
fhir:l <http://terminology.hl7.org/CodeSystem/v2-0203> ] ;
fhir:code [ fhir:v "ACSN" ] ;
fhir:display [ fhir:v "Accession ID" ] ] ) ] ;
fhir:system [
fhir:v "http://payer.example.org/claimresponses"^^xsd:anyURI ;
fhir:l <http://payer.example.org/claimresponses> ] ;
fhir:value [ fhir:v "CR-2025-0001" ]
] ) ; #
fhir:status [ fhir:v "active"] ; #
fhir:type [
( fhir:coding [
fhir:system [
fhir:v "http://terminology.hl7.org/CodeSystem/claim-type"^^xsd:anyURI ;
fhir:l <http://terminology.hl7.org/CodeSystem/claim-type> ] ;
fhir:code [ fhir:v "professional" ] ;
fhir:display [ fhir:v "Professional" ] ] )
] ; #
fhir:use [ fhir:v "claim"] ; #
fhir:patient [
fhir:l fhir:Patient/p-001 ;
fhir:reference [ fhir:v "Patient/p-001" ] ;
fhir:display [ fhir:v "Jane Patient" ]
] ; #
fhir:created [ fhir:v "2025-11-15"^^xsd:date] ; #
fhir:insurer [
fhir:l fhir:Organization/ins-001 ;
fhir:reference [ fhir:v "Organization/ins-001" ] ;
fhir:display [ fhir:v "Acme Health Insurance" ]
] ; #
fhir:requestor [
fhir:l fhir:Organization/org-001 ;
fhir:reference [ fhir:v "Organization/org-001" ] ;
fhir:display [ fhir:v "Acme Health Center" ]
] ; #
fhir:request [
fhir:l fhir:Claim/claim-001 ;
fhir:reference [ fhir:v "Claim/claim-001" ] ;
fhir:display [ fhir:v "OP consult claim" ]
] ; #
fhir:outcome [ fhir:v "complete"] ; #
fhir:disposition [ fhir:v "Approved per plan rules. Member copay applied."] ; #
fhir:preAuthRef [ fhir:v "PA-556677"] ; #
fhir:item ( [
fhir:itemSequence [ fhir:v "1"^^xsd:positiveInteger ] ;
( fhir:adjudication [
fhir:category [
( fhir:coding [
fhir:system [
fhir:v "http://terminology.hl7.org/CodeSystem/adjudication"^^xsd:anyURI ;
fhir:l <http://terminology.hl7.org/CodeSystem/adjudication> ] ;
fhir:code [ fhir:v "eligible" ] ;
fhir:display [ fhir:v "Eligible" ] ] ) ] ;
fhir:amount [
fhir:value [ fhir:v "100"^^xsd:decimal ] ;
fhir:currency [ fhir:v "USD" ] ] ] [
fhir:category [
( fhir:coding [
fhir:system [
fhir:v "http://terminology.hl7.org/CodeSystem/adjudication"^^xsd:anyURI ;
fhir:l <http://terminology.hl7.org/CodeSystem/adjudication> ] ;
fhir:code [ fhir:v "copay" ] ;
fhir:display [ fhir:v "Copay" ] ] ) ] ;
fhir:amount [
fhir:value [ fhir:v "20"^^xsd:decimal ] ;
fhir:currency [ fhir:v "USD" ] ] ] [
fhir:category [
( fhir:coding [
fhir:system [
fhir:v "http://terminology.hl7.org/CodeSystem/adjudication"^^xsd:anyURI ;
fhir:l <http://terminology.hl7.org/CodeSystem/adjudication> ] ;
fhir:code [ fhir:v "benefit" ] ;
fhir:display [ fhir:v "Benefit amount" ] ] ) ] ;
fhir:amount [
fhir:value [ fhir:v "80"^^xsd:decimal ] ;
fhir:currency [ fhir:v "USD" ] ] ] ) ;
( fhir:detail [
fhir:detailSequence [ fhir:v "1"^^xsd:positiveInteger ] ;
( fhir:adjudication [
fhir:category [
( fhir:coding [
fhir:system [
fhir:v "http://terminology.hl7.org/CodeSystem/adjudication"^^xsd:anyURI ;
fhir:l <http://terminology.hl7.org/CodeSystem/adjudication> ] ;
fhir:code [ fhir:v "eligible" ] ;
fhir:display [ fhir:v "Eligible" ] ] ) ] ;
fhir:amount [
fhir:value [ fhir:v "100"^^xsd:decimal ] ;
fhir:currency [ fhir:v "USD" ] ] ] ) ;
( fhir:subDetail [
fhir:subDetailSequence [ fhir:v "1"^^xsd:positiveInteger ] ;
( fhir:adjudication [
fhir:category [
( fhir:coding [
fhir:system [
fhir:v "http://terminology.hl7.org/CodeSystem/adjudication"^^xsd:anyURI ;
fhir:l <http://terminology.hl7.org/CodeSystem/adjudication> ] ;
fhir:code [ fhir:v "benefit" ] ;
fhir:display [ fhir:v "Benefit amount" ] ] ) ] ;
fhir:amount [
fhir:value [ fhir:v "80"^^xsd:decimal ] ;
fhir:currency [ fhir:v "USD" ] ] ] ) ] ) ] )
] ) ; #
fhir:addItem ( [
fhir:productOrService [
( fhir:coding [
fhir:system [
fhir:v "http://example.org/codes/payer-adjustment"^^xsd:anyURI ;
fhir:l <http://example.org/codes/payer-adjustment> ] ;
fhir:code [ fhir:v "ADJ001" ] ;
fhir:display [ fhir:v "Administrative adjustment" ] ] ) ] ;
( fhir:adjudication [
fhir:category [
( fhir:coding [
fhir:system [
fhir:v "http://terminology.hl7.org/CodeSystem/adjudication"^^xsd:anyURI ;
fhir:l <http://terminology.hl7.org/CodeSystem/adjudication> ] ;
fhir:code [ fhir:v "eligible" ] ;
fhir:display [ fhir:v "Eligible" ] ] ) ] ;
fhir:amount [
fhir:value [ fhir:v "0"^^xsd:decimal ] ;
fhir:currency [ fhir:v "USD" ] ] ] )
] ) ; #
fhir:total ( [
fhir:category [
( fhir:coding [
fhir:system [
fhir:v "http://terminology.hl7.org/CodeSystem/adjudication"^^xsd:anyURI ;
fhir:l <http://terminology.hl7.org/CodeSystem/adjudication> ] ;
fhir:code [ fhir:v "submitted" ] ;
fhir:display [ fhir:v "Submitted Amount" ] ] ) ] ;
fhir:amount [
fhir:value [ fhir:v "100"^^xsd:decimal ] ;
fhir:currency [ fhir:v "USD" ] ]
] [
fhir:category [
( fhir:coding [
fhir:system [
fhir:v "http://terminology.hl7.org/CodeSystem/adjudication"^^xsd:anyURI ;
fhir:l <http://terminology.hl7.org/CodeSystem/adjudication> ] ;
fhir:code [ fhir:v "copay" ] ;
fhir:display [ fhir:v "Copay" ] ] ) ] ;
fhir:amount [
fhir:value [ fhir:v "20"^^xsd:decimal ] ;
fhir:currency [ fhir:v "USD" ] ]
] [
fhir:category [
( fhir:coding [
fhir:system [
fhir:v "http://terminology.hl7.org/CodeSystem/adjudication"^^xsd:anyURI ;
fhir:l <http://terminology.hl7.org/CodeSystem/adjudication> ] ;
fhir:code [ fhir:v "benefit" ] ;
fhir:display [ fhir:v "Benefit Amount" ] ] ) ] ;
fhir:amount [
fhir:value [ fhir:v "80"^^xsd:decimal ] ;
fhir:currency [ fhir:v "USD" ] ]
] ) ; #
fhir:payment [
fhir:type [
( fhir:coding [
fhir:system [
fhir:v "http://terminology.hl7.org/CodeSystem/ex-paymenttype"^^xsd:anyURI ;
fhir:l <http://terminology.hl7.org/CodeSystem/ex-paymenttype> ] ;
fhir:code [ fhir:v "payment" ] ;
fhir:display [ fhir:v "Payment" ] ] ) ] ;
fhir:date [ fhir:v "2025-11-16"^^xsd:date ] ;
fhir:amount [
fhir:value [ fhir:v "80"^^xsd:decimal ] ;
fhir:currency [ fhir:v "USD" ] ] ;
fhir:identifier [
fhir:system [
fhir:v "http://payer.example.org/erds"^^xsd:anyURI ;
fhir:l <http://payer.example.org/erds> ] ;
fhir:value [ fhir:v "EPI-778899" ] ]
] ; #
fhir:processNote ( [
fhir:number [ fhir:v "1"^^xsd:positiveInteger ] ;
fhir:type [ fhir:v "display" ] ;
fhir:text [ fhir:v "Approved per plan. Member copay applied." ] ;
fhir:language [
( fhir:coding [
fhir:system [
fhir:v "urn:ietf:bcp:47"^^xsd:anyURI ;
fhir:l <urn:ietf:bcp:47> ] ;
fhir:code [ fhir:v "en" ] ;
fhir:display [ fhir:v "English" ] ] ) ]
] ) ; #
fhir:insurance ( [
fhir:sequence [ fhir:v "1"^^xsd:positiveInteger ] ;
fhir:focal [ fhir:v true ] ;
fhir:coverage [
fhir:l fhir:Coverage/cov-001 ;
fhir:reference [ fhir:v "Coverage/cov-001" ] ;
fhir:display [ fhir:v "Primary PPO coverage" ] ]
] ) . #
IG © 2025+ Kathurima Kimathi. Package hie-fhir-ig-profile#0.1.0 based on FHIR 4.3.0. Generated 2025-11-25
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