CR-00001
type: Claim
node role: treeRoot
id:
  v: CR-00001
meta:
  profile:
    v: https://fhir.dha.go.ke/eclaims/StructureDefinition/ke-eclaims-claim
    l: ke-eclaims-claim
text:
  status:
    v: generated
  div:
    v: 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 - Claim Relationship * Claim: status = active; type = Institutional; use = claim; created = 2025-01-01; priority = Normal Associated originalPrescription: MedicationRequest: status = active; intent = order; medication[x] = Payees - Type Party * Provider Organization Nairobi General Hospital referral: ServiceRequest facility: Location Main Ward CareTeams - Sequence Provider Role Qualification * 1 Practitioner Dr. James Kamau Primary Provider Doctor of Medicine SupportingInfos - Sequence Category Value[x] * 1 Attachment application/pdf @ https://api-edi.provider.sha.go.ke/media/claim/CHURCHILL_X-RAY.pdf Diagnoses - Sequence Diagnosis[x] Type * 1 Fracture of shaft of femur Principal Diagnosis Insurances - Sequence Focal Coverage * 1 true Coverage: status = active item sequence: 1 careTeamSequence: 1 productOrService: Open reduction and internal fixation: Femur quantity: 1 UnitPrices - Value Currency * 145600 Kenyan shilling Nets - Value Currency * 145600 Kenyan shilling Totals - Value Currency * 145600 Kenyan shilling
identifier:
  system:
    v: https://fhir.dha.go.ke/eclaims/Identifier/claim-number
    l: claim-number
  value:
    v: CLAIM-00001
status:
  v: active
type:
  coding:
    system:
      v: http://terminology.hl7.org/CodeSystem/claim-type
      l: claim-type
    code:
      v: institutional
    display:
      v: Institutional
sub type:
  coding:
    system:
      v: https://fhir.dha.go.ke/eclaims/CodeSystem/claim-subtype-cs
      l: claim-subtype-cs
    code:
      v: inpatient
    display:
      v: Inpatient
use:
  v: preauthorization
patient:
  l: PT-0001
  reference:
    v: Patient/PT-0001
billable period:
  start:
    v: 2025-11-01
  end:
    v: 2025-11-30
created:
  v: 2025-12-16T12:00:00+03:00
insurer:
  l: INS-001
  reference:
    v: Organization/INS-001
provider:
  l: ORG-001
  reference:
    v: Organization/ORG-001
priority:
  coding:
    system:
      v: http://terminology.hl7.org/CodeSystem/processpriority
      l: processpriority
    code:
      v: normal
    display:
      v: Normal
related:
  claim:
    l: CLAIM-0000X
    reference:
      v: Claim/CLAIM-0000X
  relationship:
    coding:
      system:
        v: https://fhir.dha.go.ke/eclaims/CodeSystem/related-claim-relationship-cs
        l: related-claim-relationship-cs
      code:
        v: associated
      display:
        v: Associated
original prescription:
  l: MED-0001
  reference:
    v: MedicationRequest/MED-0001
payee:
  type:
    coding:
      system:
        v: http://terminology.hl7.org/CodeSystem/payeetype
        l: payeetype
      code:
        v: provider
      display:
        v: Provider
  party:
    l: ORG-001
    reference:
      v: Organization/ORG-001
referral:
  l: SRV-0001
  reference:
    v: ServiceRequest/SRV-0001
facility:
  l: LOC-001
  reference:
    v: Location/LOC-001
care team:
  sequence:
    v: 1
  provider:
    l: PRA-001
    reference:
      v: Practitioner/PRA-001
  role:
    coding:
      system:
        v: http://terminology.hl7.org/CodeSystem/claimcareteamrole
        l: claimcareteamrole
      code:
        v: primary
      display:
        v: Primary Provider
  qualification:
    coding:
      system:
        v: http://terminology.hl7.org/CodeSystem/v2-0360
        l: v2-0360
      code:
        v: MD
      display:
        v: Doctor of Medicine
supporting info:
  sequence:
    v: 1
  category:
    coding:
      system:
        v: http://terminology.hl7.org/CodeSystem/claiminformationcategory
        l: claiminformationcategory
      code:
        v: attachment
      display:
        v: Attachment
  value: Attachment
    content type:
      v: application/pdf
    url:
      v: https://api-edi.provider.sha.go.ke/media/claim/CHURCHILL_X-RAY.pdf
      l: CHURCHILL X-RAY.pdf
    title:
      v: CHURCHILL X-RAY
    creation:
      v: 2025-11-29T15:17:07+03:00
diagnosis:
  sequence:
    v: 1
  diagnosis: CodeableConcept
    coding:
      system:
        v: http://id.who.int/icd/release/11/mms
        l: mms
      code:
        v: NC72.5
      display:
        v: Fracture of shaft of femur
  type:
    coding:
      system:
        v: http://terminology.hl7.org/CodeSystem/ex-diagnosistype
        l: ex-diagnosistype
      code:
        v: principal
      display:
        v: Principal Diagnosis
insurance:
  sequence:
    v: 1
  focal:
    v: true
  coverage:
    l: COV-0001
    reference:
      v: Coverage/COV-0001
item:
  sequence:
    v: 1
  care team sequence:
    v: 1
  product or service:
    coding:
      system:
        v: https://fhir.dha.go.ke/eclaims/CodeSystem/KenyaSocialHealthAuthorityInterventionCS
        l: KenyaSocialHealthAuthorityInterventionCS
      code:
        v: SHA-19-444
      display:
        v: Open reduction and internal fixation: Femur
  quantity:
    value:
      v: 1

value:
  v: 145600
currency:
  v: KES

value:
  v: 145600
currency:
  v: KES

value:
  v: 145600
currency:
  v: KES