Kenya eClaims FHIR Implementation Guide - Local Development build (v0.1.0) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions

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: Example Claim Response - XML Representation

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<Claim xmlns="http://hl7.org/fhir">
  <id value="CR-00001"/>
  <meta>
    <profile
             value="https://fhir.dha.go.ke/eclaims/StructureDefinition/ke-eclaims-claim"/>
  </meta>
  <text>
    <status value="generated"/>
    <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>
  </text>
  <identifier>
    <system value="https://fhir.dha.go.ke/eclaims/Identifier/claim-number"/>
    <value value="CLAIM-00001"/>
  </identifier>
  <status value="active"/>
  <type>
    <coding>
      <system value="http://terminology.hl7.org/CodeSystem/claim-type"/>
      <code value="institutional"/>
      <display value="Institutional"/>
    </coding>
  </type>
  <subType>
    <coding>
      <system
              value="https://fhir.dha.go.ke/eclaims/CodeSystem/claim-subtype-cs"/>
      <code value="inpatient"/>
      <display value="Inpatient"/>
    </coding>
  </subType>
  <use value="preauthorization"/>
  <patient>🔗 
    <reference value="Patient/PT-0001"/>
  </patient>
  <billablePeriod>
    <start value="2025-11-01"/>
    <end value="2025-11-30"/>
  </billablePeriod>
  <created value="2025-12-16T12:00:00+03:00"/>
  <insurer>🔗 
    <reference value="Organization/INS-001"/>
  </insurer>
  <provider>🔗 
    <reference value="Organization/ORG-001"/>
  </provider>
  <priority>
    <coding>
      <system value="http://terminology.hl7.org/CodeSystem/processpriority"/>
      <code value="normal"/>
      <display value="Normal"/>
    </coding>
  </priority>
  <related>
    <claim>🔗 
      <reference value="Claim/CLAIM-0000X"/>
    </claim>
    <relationship>
      <coding>
        <system
                value="https://fhir.dha.go.ke/eclaims/CodeSystem/related-claim-relationship-cs"/>
        <code value="associated"/>
        <display value="Associated"/>
      </coding>
    </relationship>
  </related>
  <originalPrescription>🔗 
    <reference value="MedicationRequest/MED-0001"/>
  </originalPrescription>
  <payee>
    <type>
      <coding>
        <system value="http://terminology.hl7.org/CodeSystem/payeetype"/>
        <code value="provider"/>
        <display value="Provider"/>
      </coding>
    </type>
    <party>🔗 
      <reference value="Organization/ORG-001"/>
    </party>
  </payee>
  <referral>🔗 
    <reference value="ServiceRequest/SRV-0001"/>
  </referral>
  <facility>🔗 
    <reference value="Location/LOC-001"/>
  </facility>
  <careTeam>
    <sequence value="1"/>
    <provider>🔗 
      <reference value="Practitioner/PRA-001"/>
    </provider>
    <role>
      <coding>
        <system
                value="http://terminology.hl7.org/CodeSystem/claimcareteamrole"/>
        <code value="primary"/>
        <display value="Primary Provider"/>
      </coding>
    </role>
    <qualification>
      <coding>
        <system value="http://terminology.hl7.org/CodeSystem/v2-0360"/>
        <code value="MD"/>
        <display value="Doctor of Medicine"/>
      </coding>
    </qualification>
  </careTeam>
  <supportingInfo>
    <sequence value="1"/>
    <category>
      <coding>
        <system
                value="http://terminology.hl7.org/CodeSystem/claiminformationcategory"/>
        <code value="attachment"/>
        <display value="Attachment"/>
      </coding>
    </category>
    <valueAttachment>
      <contentType value="application/pdf"/>
      <url
           value="https://api-edi.provider.sha.go.ke/media/claim/CHURCHILL_X-RAY.pdf"/>
      <title value="CHURCHILL X-RAY"/>
      <creation value="2025-11-29T15:17:07+03:00"/>
    </valueAttachment>
  </supportingInfo>
  <diagnosis>
    <sequence value="1"/>
    <diagnosisCodeableConcept>
      <coding>
        <system value="http://id.who.int/icd/release/11/mms"/>
        <code value="NC72.5"/>
        <display value="Fracture of shaft of femur"/>
      </coding>
    </diagnosisCodeableConcept>
    <type>
      <coding>
        <system
                value="http://terminology.hl7.org/CodeSystem/ex-diagnosistype"/>
        <code value="principal"/>
        <display value="Principal Diagnosis"/>
      </coding>
    </type>
  </diagnosis>
  <insurance>
    <sequence value="1"/>
    <focal value="true"/>
    <coverage>🔗 
      <reference value="Coverage/COV-0001"/>
    </coverage>
  </insurance>
  <item>
    <sequence value="1"/>
    <careTeamSequence value="1"/>
    <productOrService>
      <coding>
        <system
                value="https://fhir.dha.go.ke/eclaims/CodeSystem/KenyaSocialHealthAuthorityInterventionCS"/>
        <code value="SHA-19-444"/>
        <display value="Open reduction and internal fixation: Femur"/>
      </coding>
    </productOrService>
    <quantity>
      <value value="1"/>
    </quantity>
    <unitPrice>
      <value value="145600"/>
      <currency value="KES"/>
    </unitPrice>
    <net>
      <value value="145600"/>
      <currency value="KES"/>
    </net>
  </item>
  <total>
    <value value="145600"/>
    <currency value="KES"/>
  </total>
</Claim>