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 |
<CodeSystem xmlns="http://hl7.org/fhir">
<id value="payer-benefit-codesystem"/>
<text>
<status value="generated"/>
<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>
</text>
<url
value="https://fhir.slade360.co.ke/fhir/CodeSystem/payer-benefit-codesystem"/>
<version value="0.1.0"/>
<name value="SGHIPayerBenefitCodeSystem"/>
<title value="SGHI Payer Benefit Code System"/>
<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>