Example Claim Response - TTL Representation - Kenya eClaims FHIR Implementation Guide v0.1.0

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: Example Claim Response - TTL Representation

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@prefix fhir: <http://hl7.org/fhir/> .
@prefix owl: <http://www.w3.org/2002/07/owl#> .
@prefix rdf: <http://www.w3.org/1999/02/22-rdf-syntax-ns#> .
@prefix rdfs: <http://www.w3.org/2000/01/rdf-schema#> .
@prefix xsd: <http://www.w3.org/2001/XMLSchema#> .

# - resource -------------------------------------------------------------------

 a fhir:Claim ;
  fhir:nodeRole fhir:treeRoot ;
  fhir:id [ fhir:v "CR-00001"] ; # 
  fhir:meta [
    ( fhir:profile [
fhir:v "https://fhir.dha.go.ke/eclaims/StructureDefinition/ke-eclaims-claim"^^xsd:anyURI ;
fhir:l <https://fhir.dha.go.ke/eclaims/StructureDefinition/ke-eclaims-claim>     ] )
  ] ; # 
  fhir:text [
fhir:status [ fhir:v "generated" ] ;
fhir:div [ fhir:v "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p class=\"res-header-id\"><b>Generated Narrative: Claim CR-00001</b></p><a name=\"CR-00001\"> </a><a name=\"hcCR-00001\"> </a><div style=\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\"><p style=\"margin-bottom: 0px\"/><p style=\"margin-bottom: 0px\">Profile: <a href=\"StructureDefinition-ke-eclaims-claim.html\">Claim Response - Preauthorization</a></p></div><p><b>identifier</b>: <code>https://fhir.dha.go.ke/eclaims/Identifier/claim-number</code>/CLAIM-00001</p><p><b>status</b>: Active</p><p><b>type</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/claim-type institutional}\">Institutional</span></p><p><b>subType</b>: <span title=\"Codes:{https://fhir.dha.go.ke/eclaims/CodeSystem/claim-subtype-cs inpatient}\">Inpatient</span></p><p><b>use</b>: Preauthorization</p><p><b>patient</b>: <a href=\"Patient-PT-0001.html\">John Doe  Male, DoB: 1980-01-01</a></p><p><b>billablePeriod</b>: 2025-11-01 --&gt; 2025-11-30</p><p><b>created</b>: 2025-12-16 12:00:00+0300</p><p><b>insurer</b>: <a href=\"Organization-INS-001.html\">Organization Kenya Insurance Company</a></p><p><b>provider</b>: <a href=\"Organization-ORG-001.html\">Organization Nairobi General Hospital</a></p><p><b>priority</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/processpriority normal}\">Normal</span></p><h3>Relateds</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Claim</b></td><td><b>Relationship</b></td></tr><tr><td style=\"display: none\">*</td><td><a href=\"Claim-CLAIM-0000X.html\">Claim: status = active; type = Institutional; use = claim; created = 2025-01-01; priority = Normal</a></td><td><span title=\"Codes:{https://fhir.dha.go.ke/eclaims/CodeSystem/related-claim-relationship-cs associated}\">Associated</span></td></tr></table><p><b>originalPrescription</b>: <a href=\"MedicationRequest-MED-0001.html\">MedicationRequest: status = active; intent = order; medication[x] = </a></p><h3>Payees</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Type</b></td><td><b>Party</b></td></tr><tr><td style=\"display: none\">*</td><td><span title=\"Codes:{http://terminology.hl7.org/CodeSystem/payeetype provider}\">Provider</span></td><td><a href=\"Organization-ORG-001.html\">Organization Nairobi General Hospital</a></td></tr></table><p><b>referral</b>: <a href=\"ServiceRequest-SRV-0001.html\">ServiceRequest </a></p><p><b>facility</b>: <a href=\"Location-LOC-001.html\">Location Main Ward</a></p><h3>CareTeams</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Sequence</b></td><td><b>Provider</b></td><td><b>Role</b></td><td><b>Qualification</b></td></tr><tr><td style=\"display: none\">*</td><td>1</td><td><a href=\"Practitioner-PRA-001.html\">Practitioner Dr. James Kamau </a></td><td><span title=\"Codes:{http://terminology.hl7.org/CodeSystem/claimcareteamrole primary}\">Primary Provider</span></td><td><span title=\"Codes:{http://terminology.hl7.org/CodeSystem/v2-0360 MD}\">Doctor of Medicine</span></td></tr></table><h3>SupportingInfos</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Sequence</b></td><td><b>Category</b></td><td><b>Value[x]</b></td></tr><tr><td style=\"display: none\">*</td><td>1</td><td><span title=\"Codes:{http://terminology.hl7.org/CodeSystem/claiminformationcategory attachment}\">Attachment</span></td><td>application/pdf @ https://api-edi.provider.sha.go.ke/media/claim/CHURCHILL_X-RAY.pdf</td></tr></table><h3>Diagnoses</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Sequence</b></td><td><b>Diagnosis[x]</b></td><td><b>Type</b></td></tr><tr><td style=\"display: none\">*</td><td>1</td><td><span title=\"Codes:{http://id.who.int/icd/release/11/mms NC72.5}\">Fracture of shaft of femur</span></td><td><span title=\"Codes:{http://terminology.hl7.org/CodeSystem/ex-diagnosistype principal}\">Principal Diagnosis</span></td></tr></table><h3>Insurances</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Sequence</b></td><td><b>Focal</b></td><td><b>Coverage</b></td></tr><tr><td style=\"display: none\">*</td><td>1</td><td>true</td><td><a href=\"Coverage-COV-0001.html\">Coverage: status = active</a></td></tr></table><blockquote><p><b>item</b></p><p><b>sequence</b>: 1</p><p><b>careTeamSequence</b>: 1</p><p><b>productOrService</b>: <span title=\"Codes:{https://fhir.dha.go.ke/eclaims/CodeSystem/KenyaSocialHealthAuthorityInterventionCS SHA-19-444}\">Open reduction and internal fixation: Femur</span></p><p><b>quantity</b>: 1</p><h3>UnitPrices</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style=\"display: none\">*</td><td>145600</td><td>Kenyan shilling</td></tr></table><h3>Nets</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style=\"display: none\">*</td><td>145600</td><td>Kenyan shilling</td></tr></table></blockquote><h3>Totals</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Value</b></td><td><b>Currency</b></td></tr><tr><td style=\"display: none\">*</td><td>145600</td><td>Kenyan shilling</td></tr></table></div>"^^rdf:XMLLiteral ]
  ] ; # 
  fhir:identifier ( [
fhir:system [
fhir:v "https://fhir.dha.go.ke/eclaims/Identifier/claim-number"^^xsd:anyURI ;
fhir:l <https://fhir.dha.go.ke/eclaims/Identifier/claim-number>     ] ;
fhir:value [ fhir:v "CLAIM-00001" ]
  ] ) ; # 
  fhir:status [ fhir:v "active"] ; # 
  fhir:type [
    ( fhir:coding [
fhir:system [
fhir:v "http://terminology.hl7.org/CodeSystem/claim-type"^^xsd:anyURI ;
fhir:l <http://terminology.hl7.org/CodeSystem/claim-type>       ] ;
fhir:code [ fhir:v "institutional" ] ;
fhir:display [ fhir:v "Institutional" ]     ] )
  ] ; # 
  fhir:subType [
    ( fhir:coding [
fhir:system [
fhir:v "https://fhir.dha.go.ke/eclaims/CodeSystem/claim-subtype-cs"^^xsd:anyURI ;
fhir:l <https://fhir.dha.go.ke/eclaims/CodeSystem/claim-subtype-cs>       ] ;
fhir:code [ fhir:v "inpatient" ] ;
fhir:display [ fhir:v "Inpatient" ]     ] )
  ] ; # 
  fhir:use [ fhir:v "preauthorization"] ; # 
  fhir:patient [
fhir:l fhir:Patient/PT-0001 ;
fhir:reference [ fhir:v "Patient/PT-0001" ]
  ] ; # 
  fhir:billablePeriod [
fhir:start [ fhir:v "2025-11-01"^^xsd:date ] ;
fhir:end [ fhir:v "2025-11-30"^^xsd:date ]
  ] ; # 
  fhir:created [ fhir:v "2025-12-16T12:00:00+03:00"^^xsd:dateTime] ; # 
  fhir:insurer [
fhir:l fhir:Organization/INS-001 ;
fhir:reference [ fhir:v "Organization/INS-001" ]
  ] ; # 
  fhir:provider [
fhir:l fhir:Organization/ORG-001 ;
fhir:reference [ fhir:v "Organization/ORG-001" ]
  ] ; # 
  fhir:priority [
    ( fhir:coding [
fhir:system [
fhir:v "http://terminology.hl7.org/CodeSystem/processpriority"^^xsd:anyURI ;
fhir:l <http://terminology.hl7.org/CodeSystem/processpriority>       ] ;
fhir:code [ fhir:v "normal" ] ;
fhir:display [ fhir:v "Normal" ]     ] )
  ] ; # 
  fhir:related ( [
fhir:claim [
fhir:l fhir:Claim/CLAIM-0000X ;
fhir:reference [ fhir:v "Claim/CLAIM-0000X" ]     ] ;
fhir:relationship [
      ( fhir:coding [
fhir:system [
fhir:v "https://fhir.dha.go.ke/eclaims/CodeSystem/related-claim-relationship-cs"^^xsd:anyURI ;
fhir:l <https://fhir.dha.go.ke/eclaims/CodeSystem/related-claim-relationship-cs>         ] ;
fhir:code [ fhir:v "associated" ] ;
fhir:display [ fhir:v "Associated" ]       ] )     ]
  ] ) ; # 
  fhir:originalPrescription [
fhir:l fhir:MedicationRequest/MED-0001 ;
fhir:reference [ fhir:v "MedicationRequest/MED-0001" ]
  ] ; # 
  fhir:payee [
fhir:type [
      ( fhir:coding [
fhir:system [
fhir:v "http://terminology.hl7.org/CodeSystem/payeetype"^^xsd:anyURI ;
fhir:l <http://terminology.hl7.org/CodeSystem/payeetype>         ] ;
fhir:code [ fhir:v "provider" ] ;
fhir:display [ fhir:v "Provider" ]       ] )     ] ;
fhir:party [
fhir:l fhir:Organization/ORG-001 ;
fhir:reference [ fhir:v "Organization/ORG-001" ]     ]
  ] ; # 
  fhir:referral [
fhir:l fhir:ServiceRequest/SRV-0001 ;
fhir:reference [ fhir:v "ServiceRequest/SRV-0001" ]
  ] ; # 
  fhir:facility [
fhir:l fhir:Location/LOC-001 ;
fhir:reference [ fhir:v "Location/LOC-001" ]
  ] ; # 
  fhir:careTeam ( [
fhir:sequence [ fhir:v "1"^^xsd:positiveInteger ] ;
fhir:provider [
fhir:l fhir:Practitioner/PRA-001 ;
fhir:reference [ fhir:v "Practitioner/PRA-001" ]     ] ;
fhir:role [
      ( fhir:coding [
fhir:system [
fhir:v "http://terminology.hl7.org/CodeSystem/claimcareteamrole"^^xsd:anyURI ;
fhir:l <http://terminology.hl7.org/CodeSystem/claimcareteamrole>         ] ;
fhir:code [ fhir:v "primary" ] ;
fhir:display [ fhir:v "Primary Provider" ]       ] )     ] ;
fhir:qualification [
      ( fhir:coding [
fhir:system [
fhir:v "http://terminology.hl7.org/CodeSystem/v2-0360"^^xsd:anyURI ;
fhir:l <http://terminology.hl7.org/CodeSystem/v2-0360>         ] ;
fhir:code [ fhir:v "MD" ] ;
fhir:display [ fhir:v "Doctor of Medicine" ]       ] )     ]
  ] ) ; # 
  fhir:supportingInfo ( [
fhir:sequence [ fhir:v "1"^^xsd:positiveInteger ] ;
fhir:category [
      ( fhir:coding [
fhir:system [
fhir:v "http://terminology.hl7.org/CodeSystem/claiminformationcategory"^^xsd:anyURI ;
fhir:l <http://terminology.hl7.org/CodeSystem/claiminformationcategory>         ] ;
fhir:code [ fhir:v "attachment" ] ;
fhir:display [ fhir:v "Attachment" ]       ] )     ] ;
fhir:value [
a fhir:Attachment ;
fhir:contentType [ fhir:v "application/pdf" ] ;
fhir:url [
fhir:v "https://api-edi.provider.sha.go.ke/media/claim/CHURCHILL_X-RAY.pdf"^^xsd:anyURI ;
fhir:l <https://api-edi.provider.sha.go.ke/media/claim/CHURCHILL_X-RAY.pdf>       ] ;
fhir:title [ fhir:v "CHURCHILL X-RAY" ] ;
fhir:creation [ fhir:v "2025-11-29T15:17:07+03:00"^^xsd:dateTime ]     ]
  ] ) ; # 
  fhir:diagnosis ( [
fhir:sequence [ fhir:v "1"^^xsd:positiveInteger ] ;
fhir:diagnosis [
a fhir:CodeableConcept ;
      ( fhir:coding [
fhir:system [
fhir:v "http://id.who.int/icd/release/11/mms"^^xsd:anyURI ;
fhir:l <http://id.who.int/icd/release/11/mms>         ] ;
fhir:code [ fhir:v "NC72.5" ] ;
fhir:display [ fhir:v "Fracture of shaft of femur" ]       ] )     ] ;
    ( fhir:type [
      ( fhir:coding [
fhir:system [
fhir:v "http://terminology.hl7.org/CodeSystem/ex-diagnosistype"^^xsd:anyURI ;
fhir:l <http://terminology.hl7.org/CodeSystem/ex-diagnosistype>         ] ;
fhir:code [ fhir:v "principal" ] ;
fhir:display [ fhir:v "Principal Diagnosis" ]       ] )     ] )
  ] ) ; # 
  fhir:insurance ( [
fhir:sequence [ fhir:v "1"^^xsd:positiveInteger ] ;
fhir:focal [ fhir:v true ] ;
fhir:coverage [
fhir:l fhir:Coverage/COV-0001 ;
fhir:reference [ fhir:v "Coverage/COV-0001" ]     ]
  ] ) ; # 
  fhir:item ( [
fhir:sequence [ fhir:v "1"^^xsd:positiveInteger ] ;
    ( fhir:careTeamSequence [ fhir:v "1"^^xsd:positiveInteger ] ) ;
fhir:productOrService [
      ( fhir:coding [
fhir:system [
fhir:v "https://fhir.dha.go.ke/eclaims/CodeSystem/KenyaSocialHealthAuthorityInterventionCS"^^xsd:anyURI ;
fhir:l <https://fhir.dha.go.ke/eclaims/CodeSystem/KenyaSocialHealthAuthorityInterventionCS>         ] ;
fhir:code [ fhir:v "SHA-19-444" ] ;
fhir:display [ fhir:v "Open reduction and internal fixation: Femur" ]       ] )     ] ;
fhir:quantity [
fhir:value [ fhir:v "1"^^xsd:decimal ]     ] ;
fhir:unitPrice [
fhir:value [ fhir:v "145600"^^xsd:decimal ] ;
fhir:currency [ fhir:v "KES" ]     ] ;
fhir:net [
fhir:value [ fhir:v "145600"^^xsd:decimal ] ;
fhir:currency [ fhir:v "KES" ]     ]
  ] ) ; # 
  fhir:total [
fhir:value [ fhir:v "145600"^^xsd:decimal ] ;
fhir:currency [ fhir:v "KES" ]
  ] . #