{ "resourceType" : "Claim", "id" : "CR-00001", "meta" : { "profile" : ["https://fhir.dha.go.ke/eclaims/StructureDefinition/ke-eclaims-claim"] }, "text" : { "status" : "generated", "div" : "

Generated Narrative: Claim CR-00001

Profile: Claim Response - Preauthorization

identifier: https://fhir.dha.go.ke/eclaims/Identifier/claim-number/CLAIM-00001

status: Active

type: Institutional

subType: Inpatient

use: Preauthorization

patient: John Doe Male, DoB: 1980-01-01

billablePeriod: 2025-11-01 --> 2025-11-30

created: 2025-12-16 12:00:00+0300

insurer: Organization Kenya Insurance Company

provider: Organization Nairobi General Hospital

priority: Normal

Relateds

-ClaimRelationship
*Claim: status = active; type = Institutional; use = claim; created = 2025-01-01; priority = NormalAssociated

originalPrescription: MedicationRequest: status = active; intent = order; medication[x] =

Payees

-TypeParty
*ProviderOrganization Nairobi General Hospital

referral: ServiceRequest

facility: Location Main Ward

CareTeams

-SequenceProviderRoleQualification
*1Practitioner Dr. James Kamau Primary ProviderDoctor of Medicine

SupportingInfos

-SequenceCategoryValue[x]
*1Attachmentapplication/pdf @ https://api-edi.provider.sha.go.ke/media/claim/CHURCHILL_X-RAY.pdf

Diagnoses

-SequenceDiagnosis[x]Type
*1Fracture of shaft of femurPrincipal Diagnosis

Insurances

-SequenceFocalCoverage
*1trueCoverage: status = active

item

sequence: 1

careTeamSequence: 1

productOrService: Open reduction and internal fixation: Femur

quantity: 1

UnitPrices

-ValueCurrency
*145600Kenyan shilling

Nets

-ValueCurrency
*145600Kenyan shilling

Totals

-ValueCurrency
*145600Kenyan shilling
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