{
  "resourceType" : "ClaimResponse",
  "id" : "8e0e3d44-4b7a-47d6-8b82-39fa646f8088",
  "meta" : {
    "profile" : ["https://fhir.dha.go.ke/eclaims/StructureDefinition/ke-eclaims-claimresponse"]
  },
  "text" : {
    "status" : "extensions",
    "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p class=\"res-header-id\"><b>Generated Narrative: ClaimResponse 8e0e3d44-4b7a-47d6-8b82-39fa646f8088</b></p><a name=\"8e0e3d44-4b7a-47d6-8b82-39fa646f8088\"> </a><a name=\"hc8e0e3d44-4b7a-47d6-8b82-39fa646f8088\"> </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-claimresponse.html\">Kenya eClaims ClaimResponse Profile</a></p></div><p><b>Claim Workflow State</b>: <span title=\"Codes:{https://fhir.dha.go.ke/eclaims/CodeSystem/claim-state-cs sent-back}\">Sent Back</span></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>use</b>: Claim</p><p><b>patient</b>: <a href=\"Patient-example.html\">Jane Wanjiku  Female, DoB: 1985-06-15</a></p><p><b>created</b>: 2025-10-07 18:47:22+0000</p><p><b>insurer</b>: <a href=\"Organization-sha-insurer.html\">Social Health Authority</a></p><p><b>request</b>: <a href=\"Claim-ae044c1d-9ecb-4294-be9b-0702e7892596.html\">Claim: status = active; type = Institutional; use = claim; created = 2025-10-01; priority = Normal</a></p><p><b>outcome</b>: Processing Complete</p><blockquote><p><b>item</b></p><p><b>itemSequence</b>: 1</p><blockquote><p><b>adjudication</b></p><p><b>category</b>: <span title=\"Codes:\">benefit</span></p><p><b>reason</b>: <span title=\"Codes:\">Auto Approved.</span></p><h3>Amounts</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>11200</td><td>Kenyan shilling</td></tr></table></blockquote></blockquote><blockquote><p><b>total</b></p><p><b>category</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/adjudication benefit}\">Benefit Amount</span></p><h3>Amounts</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>11200</td><td>Kenyan shilling</td></tr></table></blockquote><blockquote><p><b>processNote</b></p><p><b>number</b>: 1</p><p><b>type</b>: Display</p><p><b>text</b>: medical cases</p></blockquote><blockquote><p><b>processNote</b></p><p><b>number</b>: 2</p><p><b>type</b>: Display</p><p><b>text</b>: For surveillance review</p></blockquote></div>"
  },
  "extension" : [{
    "url" : "https://fhir.dha.go.ke/eclaims/StructureDefinition/claim-state-extension",
    "valueCodeableConcept" : {
      "coding" : [{
        "system" : "https://fhir.dha.go.ke/eclaims/CodeSystem/claim-state-cs",
        "code" : "sent-back",
        "display" : "Sent Back"
      }]
    }
  }],
  "status" : "active",
  "type" : {
    "coding" : [{
      "system" : "http://terminology.hl7.org/CodeSystem/claim-type",
      "code" : "institutional"
    }]
  },
  "use" : "claim",
  "patient" : {
    "reference" : "Patient/example"
  },
  "created" : "2025-10-07T18:47:22+00:00",
  "insurer" : {
    "reference" : "Organization/sha-insurer",
    "display" : "Social Health Authority"
  },
  "request" : {
    "reference" : "Claim/ae044c1d-9ecb-4294-be9b-0702e7892596"
  },
  "outcome" : "complete",
  "item" : [{
    "itemSequence" : 1,
    "adjudication" : [{
      "category" : {
        "text" : "benefit"
      },
      "reason" : {
        "text" : "Auto Approved."
      },
      "amount" : {
        "value" : 11200,
        "currency" : "KES"
      }
    }]
  }],
  "total" : [{
    "category" : {
      "coding" : [{
        "system" : "http://terminology.hl7.org/CodeSystem/adjudication",
        "code" : "benefit"
      }]
    },
    "amount" : {
      "value" : 11200,
      "currency" : "KES"
    }
  }],
  "processNote" : [{
    "number" : 1,
    "type" : "display",
    "text" : "medical cases"
  },
  {
    "number" : 2,
    "type" : "display",
    "text" : "For surveillance review"
  }]
}