{ "resourceType" : "CodeSystem", "id" : "payer-benefit-codesystem", "text" : { "status" : "generated", "div" : "

Generated Narrative: CodeSystem payer-benefit-codesystem

Properties

This code system defines the following properties for its concepts

NameCodeURITypeDescription
requires-preauthorisationrequires-preauthorisationhttps://fhir.slade360.co.ke/fhir/concept-properties#requires-preauthorisationbooleanTrue where the payer requires pre-authorisation before the intervention is delivered.
emergency-benefitemergency-benefithttps://fhir.slade360.co.ke/fhir/concept-properties#emergency-benefitbooleanTrue 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 AuthorityA public scheme capped in bed-days per household per year, pooled across the household.
private Private insuranceA private scheme capped in shillings.
benefit-inpatient Inpatient managementThe SHA inpatient benefit package.
benefit-corporate-inpatient Corporate inpatientA private corporate inpatient benefit package.
per-night Per nightThe tariff is claimed for each night of stay.
per-episode Per episodeThe tariff is claimed once for the episode.
SHA-IP-MED-01 Medical inpatient managementGeneral medical inpatient management, claimed per night.truefalse
SHA-IP-HDU-02 High dependency careHigh dependency inpatient care, claimed per night.truefalse
SHA-MAT-ND-01 Normal deliveryNormal delivery, claimed per episode.falsefalse
SHA-MAT-CS-02 Caesarean sectionCaesarean section, claimed per episode.truefalse
SHA-EMC-STB-01 Emergency stabilisation and treatmentEmergency stabilisation, claimed per episode from the emergency fund.falsetrue
SHA-EMC-CRIT-02 Emergency critical care, first 24 hoursEmergency critical care for the first 24 hours, claimed per night from the emergency fund.falsetrue
" }, "url" : "https://fhir.slade360.co.ke/fhir/CodeSystem/payer-benefit-codesystem", "version" : "0.1.0", "name" : "SGHIPayerBenefitCodeSystem", "title" : "SGHI Payer Benefit Code System", "status" : "active", "experimental" : false, "date" : "2026-09-15T11:40:24+00:00", "publisher" : "Kathurima Kimathi", "contact" : [{ "name" : "Kathurima Kimathi", "telecom" : [{ "system" : "url", "value" : "https://www.linkedin.com/in/kathurima-kimathi/" }, { "system" : "email", "value" : "kathurimakimathi415@gmail.com" }] }, { "name" : "Oscar John", "telecom" : [{ "system" : "email", "value" : "oscarjohnotieno@gmail.com", "use" : "work" }] }, { "name" : "Kennedy Omondi", "telecom" : [{ "system" : "email", "value" : "kennankole@gmail.com", "use" : "work" }] }], "description" : "Payer schemes, benefit packages, tariff rules and the Social Health Authority intervention codes read when admitting an insured patient.", "caseSensitive" : true, "content" : "complete", "count" : 12, "property" : [{ "code" : "requires-preauthorisation", "uri" : "https://fhir.slade360.co.ke/fhir/concept-properties#requires-preauthorisation", "description" : "True where the payer requires pre-authorisation before the intervention is delivered.", "type" : "boolean" }, { "code" : "emergency-benefit", "uri" : "https://fhir.slade360.co.ke/fhir/concept-properties#emergency-benefit", "description" : "True where the intervention is funded from the emergency fund rather than a benefit package.", "type" : "boolean" }], "concept" : [{ "code" : "sha", "display" : "Social Health Authority", "definition" : "A public scheme capped in bed-days per household per year, pooled across the household." }, { "code" : "private", "display" : "Private insurance", "definition" : "A private scheme capped in shillings." }, { "code" : "benefit-inpatient", "display" : "Inpatient management", "definition" : "The SHA inpatient benefit package." }, { "code" : "benefit-corporate-inpatient", "display" : "Corporate inpatient", "definition" : "A private corporate inpatient benefit package." }, { "code" : "per-night", "display" : "Per night", "definition" : "The tariff is claimed for each night of stay." }, { "code" : "per-episode", "display" : "Per episode", "definition" : "The tariff is claimed once for the episode." }, { "code" : "SHA-IP-MED-01", "display" : "Medical inpatient management", "definition" : "General medical inpatient management, claimed per night.", "property" : [{ "code" : "requires-preauthorisation", "valueBoolean" : true }, { "code" : "emergency-benefit", "valueBoolean" : false }] }, { "code" : "SHA-IP-HDU-02", "display" : "High dependency care", "definition" : "High dependency inpatient care, claimed per night.", "property" : [{ "code" : "requires-preauthorisation", "valueBoolean" : true }, { "code" : "emergency-benefit", "valueBoolean" : false }] }, { "code" : "SHA-MAT-ND-01", "display" : "Normal delivery", "definition" : "Normal delivery, claimed per episode.", "property" : [{ "code" : "requires-preauthorisation", "valueBoolean" : false }, { "code" : "emergency-benefit", "valueBoolean" : false }] }, { "code" : "SHA-MAT-CS-02", "display" : "Caesarean section", "definition" : "Caesarean section, claimed per episode.", "property" : [{ "code" : "requires-preauthorisation", "valueBoolean" : true }, { "code" : "emergency-benefit", "valueBoolean" : false }] }, { "code" : "SHA-EMC-STB-01", "display" : "Emergency stabilisation and treatment", "definition" : "Emergency stabilisation, claimed per episode from the emergency fund.", "property" : [{ "code" : "requires-preauthorisation", "valueBoolean" : false }, { "code" : "emergency-benefit", "valueBoolean" : true }] }, { "code" : "SHA-EMC-CRIT-02", "display" : "Emergency critical care, first 24 hours", "definition" : "Emergency critical care for the first 24 hours, claimed per night from the emergency fund.", "property" : [{ "code" : "requires-preauthorisation", "valueBoolean" : false }, { "code" : "emergency-benefit", "valueBoolean" : true }] }] }