SGHI FHIR Profile Implementation Guide
0.1.0 - ci-build

SGHI FHIR Profile 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/sil_fhir_profile_ig/ and changes regularly. See the Directory of published versions

CodeSystem: SGHI Payer Benefit Code System

Official URL: https://fhir.slade360.co.ke/fhir/CodeSystem/payer-benefit-codesystem Version: 0.1.0
Active as of 2026-09-15 Computable Name: SGHIPayerBenefitCodeSystem

Payer schemes, benefit packages, tariff rules and the Social Health Authority intervention codes read when admitting an insured patient.

This Code system is referenced in the content logical definition of the following value sets:

Properties

This code system defines the following properties for its concepts

NameCodeURITypeDescription
requires-preauthorisation requires-preauthorisation https://fhir.slade360.co.ke/fhir/concept-properties#requires-preauthorisation boolean True where the payer requires pre-authorisation before the intervention is delivered.
emergency-benefit emergency-benefit https://fhir.slade360.co.ke/fhir/concept-properties#emergency-benefit boolean True where the intervention is funded from the emergency fund rather than a benefit package.

Concepts

This case-sensitive code system https://fhir.slade360.co.ke/fhir/CodeSystem/payer-benefit-codesystem defines the following codes:

CodeDisplayDefinitionrequires-preauthorisationemergency-benefit
sha Social Health Authority A public scheme capped in bed-days per household per year, pooled across the household.
private Private insurance A private scheme capped in shillings.
benefit-inpatient Inpatient management The SHA inpatient benefit package.
benefit-corporate-inpatient Corporate inpatient A private corporate inpatient benefit package.
per-night Per night The tariff is claimed for each night of stay.
per-episode Per episode The tariff is claimed once for the episode.
SHA-IP-MED-01 Medical inpatient management General medical inpatient management, claimed per night. true false
SHA-IP-HDU-02 High dependency care High dependency inpatient care, claimed per night. true false
SHA-MAT-ND-01 Normal delivery Normal delivery, claimed per episode. false false
SHA-MAT-CS-02 Caesarean section Caesarean section, claimed per episode. true false
SHA-EMC-STB-01 Emergency stabilisation and treatment Emergency stabilisation, claimed per episode from the emergency fund. false true
SHA-EMC-CRIT-02 Emergency critical care, first 24 hours Emergency critical care for the first 24 hours, claimed per night from the emergency fund. false true