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