https://fhir.dha.go.ke/eclaims/ClaimResponse/8e0e3d44-4b7a-47d6-8b82-39fa646f8088
type: ClaimResponse
node role: treeRoot
meta:
  profile:
    v: https://fhir.dha.go.ke/eclaims/StructureDefinition/ke-eclaims-claimresponse
    l: ke-eclaims-claimresponse
text:
  status:
    v: extensions
  div:
    v: Generated Narrative: ClaimResponse 8e0e3d44-4b7a-47d6-8b82-39fa646f8088 Profile: Kenya eClaims ClaimResponse Profile Claim Workflow State: Sent Back status: Active type: Institutional use: Claim patient: Jane Wanjiku Female, DoB: 1985-06-15 created: 2025-10-07 18:47:22+0000 insurer: Social Health Authority request: Claim: status = active; type = Institutional; use = claim; created = 2025-10-01; priority = Normal outcome: Processing Complete item itemSequence: 1 adjudication category: benefit reason: Auto Approved. Amounts - Value Currency * 11200 Kenyan shilling total category: Benefit Amount Amounts - Value Currency * 11200 Kenyan shilling processNote number: 1 type: Display text: medical cases processNote number: 2 type: Display text: For surveillance review
extension:
  url:
    v: https://fhir.dha.go.ke/eclaims/StructureDefinition/claim-state-extension
    l: claim-state-extension
  value: CodeableConcept
    coding:
      system:
        v: https://fhir.dha.go.ke/eclaims/CodeSystem/claim-state-cs
        l: claim-state-cs
      code:
        v: sent-back
      display:
        v: Sent Back
status:
  v: active
type:
  coding:
    system:
      v: http://terminology.hl7.org/CodeSystem/claim-type
      l: claim-type
    code:
      v: institutional
use:
  v: claim
patient:
  l: example
  reference:
    v: Patient/example
created:
  v: 2025-10-07T18:47:22+00:00
insurer:
  l: sha-insurer
  reference:
    v: Organization/sha-insurer
  display:
    v: Social Health Authority
outcome:
  v: complete
item:
  item sequence:
    v: 1
  adjudication:
    category:
      text:
        v: benefit
    reason:
      text:
        v: Auto Approved.
    amount:
      value:
        v: 11200
      currency:
        v: KES
total:
  category:
    coding:
      system:
        v: http://terminology.hl7.org/CodeSystem/adjudication
        l: adjudication
      code:
        v: benefit
  amount:
    value:
      v: 11200
    currency:
      v: KES
process note:
  number:
    v: 1
  type:
    v: display
  text:
    v: medical cases
process note:
  number:
    v: 2
  type:
    v: display
  text:
    v: For surveillance review