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
| Active as of 2026-09-15 |
{
"resourceType" : "CodeSystem",
"id" : "payer-benefit-codesystem",
"text" : {
"status" : "generated",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p class=\"res-header-id\"><b>Generated Narrative: CodeSystem payer-benefit-codesystem</b></p><a name=\"payer-benefit-codesystem\"> </a><a name=\"hcpayer-benefit-codesystem\"> </a><p><b>Properties</b></p><p><b>This code system defines the following properties for its concepts</b></p><table class=\"grid\"><tr><td><b>Name</b></td><td><b>Code</b></td><td><b>URI</b></td><td><b>Type</b></td><td><b>Description</b></td></tr><tr><td>requires-preauthorisation</td><td>requires-preauthorisation</td><td>https://fhir.slade360.co.ke/fhir/concept-properties#requires-preauthorisation</td><td>boolean</td><td>True where the payer requires pre-authorisation before the intervention is delivered.</td></tr><tr><td>emergency-benefit</td><td>emergency-benefit</td><td>https://fhir.slade360.co.ke/fhir/concept-properties#emergency-benefit</td><td>boolean</td><td>True where the intervention is funded from the emergency fund rather than a benefit package.</td></tr></table><p><b>Concepts</b></p><p>This case-sensitive code system <code>https://fhir.slade360.co.ke/fhir/CodeSystem/payer-benefit-codesystem</code> defines the following codes:</p><table class=\"codes\"><tr><td style=\"white-space:nowrap\"><b>Code</b></td><td><b>Display</b></td><td><b>Definition</b></td><td><b>requires-preauthorisation</b></td><td><b>emergency-benefit</b></td></tr><tr><td style=\"white-space:nowrap\">sha<a name=\"payer-benefit-codesystem-sha\"> </a></td><td>Social Health Authority</td><td>A public scheme capped in bed-days per household per year, pooled across the household.</td><td/><td/></tr><tr><td style=\"white-space:nowrap\">private<a name=\"payer-benefit-codesystem-private\"> </a></td><td>Private insurance</td><td>A private scheme capped in shillings.</td><td/><td/></tr><tr><td style=\"white-space:nowrap\">benefit-inpatient<a name=\"payer-benefit-codesystem-benefit-inpatient\"> </a></td><td>Inpatient management</td><td>The SHA inpatient benefit package.</td><td/><td/></tr><tr><td style=\"white-space:nowrap\">benefit-corporate-inpatient<a name=\"payer-benefit-codesystem-benefit-corporate-inpatient\"> </a></td><td>Corporate inpatient</td><td>A private corporate inpatient benefit package.</td><td/><td/></tr><tr><td style=\"white-space:nowrap\">per-night<a name=\"payer-benefit-codesystem-per-night\"> </a></td><td>Per night</td><td>The tariff is claimed for each night of stay.</td><td/><td/></tr><tr><td style=\"white-space:nowrap\">per-episode<a name=\"payer-benefit-codesystem-per-episode\"> </a></td><td>Per episode</td><td>The tariff is claimed once for the episode.</td><td/><td/></tr><tr><td style=\"white-space:nowrap\">SHA-IP-MED-01<a name=\"payer-benefit-codesystem-SHA-IP-MED-01\"> </a></td><td>Medical inpatient management</td><td>General medical inpatient management, claimed per night.</td><td>true</td><td>false</td></tr><tr><td style=\"white-space:nowrap\">SHA-IP-HDU-02<a name=\"payer-benefit-codesystem-SHA-IP-HDU-02\"> </a></td><td>High dependency care</td><td>High dependency inpatient care, claimed per night.</td><td>true</td><td>false</td></tr><tr><td style=\"white-space:nowrap\">SHA-MAT-ND-01<a name=\"payer-benefit-codesystem-SHA-MAT-ND-01\"> </a></td><td>Normal delivery</td><td>Normal delivery, claimed per episode.</td><td>false</td><td>false</td></tr><tr><td style=\"white-space:nowrap\">SHA-MAT-CS-02<a name=\"payer-benefit-codesystem-SHA-MAT-CS-02\"> </a></td><td>Caesarean section</td><td>Caesarean section, claimed per episode.</td><td>true</td><td>false</td></tr><tr><td style=\"white-space:nowrap\">SHA-EMC-STB-01<a name=\"payer-benefit-codesystem-SHA-EMC-STB-01\"> </a></td><td>Emergency stabilisation and treatment</td><td>Emergency stabilisation, claimed per episode from the emergency fund.</td><td>false</td><td>true</td></tr><tr><td style=\"white-space:nowrap\">SHA-EMC-CRIT-02<a name=\"payer-benefit-codesystem-SHA-EMC-CRIT-02\"> </a></td><td>Emergency critical care, first 24 hours</td><td>Emergency critical care for the first 24 hours, claimed per night from the emergency fund.</td><td>false</td><td>true</td></tr></table></div>"
},
"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
}
]
}
]
}