Kenya eClaims FHIR IG
0.1.0 - ci-build Kenya flag

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

: ClaimResponse - Example - XML Representation

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<ClaimResponse xmlns="http://hl7.org/fhir">
  <id value="a236b53e-0144-41f4-a3d9-99a3fed76c35"/>
  <meta>
    <versionId value="2"/>
    <lastUpdated value="2025-01-04T11:03:06+03:00"/>
    <source value="#e4fd6c167838fdfb"/>
    <profile
             value="https://example.com/fhir/StructureDefinition/eclaims-claimresponse"/>
  </meta>
  <text>
    <status value="extensions"/>
    <div xmlns="http://www.w3.org/1999/xhtml"><p class="res-header-id"><b>Generated Narrative: ClaimResponse a236b53e-0144-41f4-a3d9-99a3fed76c35</b></p><a name="a236b53e-0144-41f4-a3d9-99a3fed76c35"> </a><a name="hca236b53e-0144-41f4-a3d9-99a3fed76c35"> </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">version: 2; Last updated: 2025-01-04 11:03:06+0300; </p><p style="margin-bottom: 0px">Information Source: #e4fd6c167838fdfb</p><p style="margin-bottom: 0px">Profile: <a href="StructureDefinition-eclaims-claimresponse.html">ClaimResponse Profile</a></p></div><p><b>com/fhir/StructureDefinition/claim-state-extension</b>: <span title="Codes:{https://uat-mis.apeiro-digital.com/fhir/CodeSystem/claim-state approved}">Approved</span></p><p><b>status</b>: Active</p><p><b>type</b>: <span title="Codes:{http://terminology.hl7.org/CodeSystem/claim-type professional}">Professional</span></p><p><b>use</b>: Claim</p><p><b>patient</b>: <a href="http://hl7.org/fhir/us/core/STU4/Patient-example.html">Amy V. Shaw  Female, DoB: 1987-02-20 ( Medical Record Number: 1032702 (use: usual, ))</a></p><p><b>created</b>: 2025-01-04 11:00:00+0300</p><p><b>insurer</b>: <a href="Organization/insurer-example">Organization/insurer-example</a></p><p><b>request</b>: <a href="Claim-f6dc7f9e-1558-4b92-adbd-447771c7b2f9.html">Claim: identifier = https://uat-mis.apeiro-digital.com/fhir/claim#f6dc7f9e-1558-4b92-adbd-447771c7b2f9; status = active; type = Institutional; subType = op; use = preauthorization; billablePeriod = 2025-01-04 --&gt; 2025-01-05; created = 2025-01-03; 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>50</td><td>KSH</td></tr></table></blockquote></blockquote><blockquote><p><b>total</b></p><p><b>category</b>: <span title="Codes:">submitted</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>50</td><td>KSH</td></tr></table></blockquote></div>
  </text>
  <extension
             url="https://uat-mis.apeiro-digital.com/fhir/StructureDefinition/claim-state-extension">
    <valueCodeableConcept>
      <coding>
        <system
                value="https://uat-mis.apeiro-digital.com/fhir/CodeSystem/claim-state"/>
        <code value="approved"/>
        <display value="Approved"/>
      </coding>
    </valueCodeableConcept>
  </extension>
  <status value="active"/>
  <type>
    <coding>
      <system value="http://terminology.hl7.org/CodeSystem/claim-type"/>
      <code value="professional"/>
      <display value="Professional"/>
    </coding>
  </type>
  <use value="claim"/>
  <patient>
    <reference value="Patient/example"/>
  </patient>
  <created value="2025-01-04T11:00:00+03:00"/>
  <insurer>
    <reference value="Organization/insurer-example"/>
  </insurer>
  <request>🔗 
    <reference value="Claim/f6dc7f9e-1558-4b92-adbd-447771c7b2f9"/>
  </request>
  <outcome value="complete"/>
  <item>
    <itemSequence value="1"/>
    <adjudication>
      <category>
        <text value="benefit"/>
      </category>
      <reason>
        <text value="Auto Approved."/>
      </reason>
      <amount>
        <value value="50"/>
        <currency value="KSH"/>
      </amount>
    </adjudication>
  </item>
  <total>
    <category>
      <text value="submitted"/>
    </category>
    <amount>
      <value value="50"/>
      <currency value="KSH"/>
    </amount>
  </total>
</ClaimResponse>