<?xml version="1.0" encoding="UTF-8"?>

<ClaimResponse xmlns="http://hl7.org/fhir">
  <id value="fd876fab-979d-4adb-8b32-46dff643b89f"/>
  <meta>
    <profile value="https://fhir.dha.go.ke/eclaims/StructureDefinition/ke-eclaims-claimresponse"/>
  </meta>
  <text>
    <status value="extensions"/><div xmlns="http://www.w3.org/1999/xhtml"><p class="res-header-id"><b>Generated Narrative: ClaimResponse fd876fab-979d-4adb-8b32-46dff643b89f</b></p><a name="fd876fab-979d-4adb-8b32-46dff643b89f"> </a><a name="hcfd876fab-979d-4adb-8b32-46dff643b89f"> </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>Preauthorization Expiry Date</b>: <span title="Codes:{https://fhir.dha.go.ke/eclaims/CodeSystem/claim-expiry-cs expiry-date}">Expiry Date</span></p><p><b>Claim Workflow State</b>: <span title="Codes:{https://fhir.dha.go.ke/eclaims/CodeSystem/claim-state-cs canceled}">Canceled</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>: Preauthorization</p><p><b>patient</b>: <a href="Patient-example.html">Jane Wanjiku  Female, DoB: 1985-06-15</a></p><p><b>created</b>: 2025-10-03 07:36:24+0000</p><p><b>insurer</b>: <a href="Organization-sha-insurer.html">Organization Social Health Authority</a></p><p><b>request</b>: <a href="Claim-a7dcd571-d8a2-483a-8a45-e3c8bcbff8b8.html">Claim: status = active; type = Institutional; use = preauthorization; 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><p><b>value</b>: 0</p></blockquote></blockquote><blockquote><p><b>total</b></p><p><b>category</b>: <span title="Codes:">benefit</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><h3>ProcessNotes</h3><table class="grid"><tr><td style="display: none">-</td><td><b>Number</b></td><td><b>Type</b></td><td><b>Text</b></td></tr><tr><td style="display: none">*</td><td>1</td><td>Display</td><td>cancelled as requested</td></tr></table></div>
  </text>
  <extension url="https://fhir.dha.go.ke/eclaims/StructureDefinition/claim-expiry-extension">
    <valueCodeableConcept>
      <coding>
        <system value="https://fhir.dha.go.ke/eclaims/CodeSystem/claim-expiry-cs"/>
        <code value="expiry-date"/>
        <display value="Expiry Date"/>
      </coding>
    </valueCodeableConcept>
  </extension>
  <extension url="https://fhir.dha.go.ke/eclaims/StructureDefinition/claim-state-extension">
    <valueCodeableConcept>
      <coding>
        <system value="https://fhir.dha.go.ke/eclaims/CodeSystem/claim-state-cs"/>
        <code value="canceled"/>
        <display value="Canceled"/>
      </coding>
    </valueCodeableConcept>
  </extension>
  <status value="active"/>
  <type>
    <coding>
      <system value="http://terminology.hl7.org/CodeSystem/claim-type"/>
      <code value="institutional"/>
    </coding>
  </type>
  <use value="preauthorization"/>
  <patient>
    <reference value="Patient/example"/>
  </patient>
  <created value="2025-10-03T07:36:24+00:00"/>
  <insurer>
    <reference value="Organization/sha-insurer"/>
  </insurer>
  <request>
    <reference value="Claim/a7dcd571-d8a2-483a-8a45-e3c8bcbff8b8"/>
  </request>
  <outcome value="complete"/>
  <item>
    <itemSequence value="1"/>
    <adjudication>
      <category>
        <text value="benefit"/>
      </category>
      <reason>
        <text value="Auto Approved."/>
      </reason>
      <amount>
        <value value="11200"/>
        <currency value="KES"/>
      </amount>
      <value value="0"/>
    </adjudication>
  </item>
  <total>
    <category>
      <text value="benefit"/>
    </category>
    <amount>
      <value value="11200"/>
      <currency value="KES"/>
    </amount>
  </total>
  <processNote>
    <number value="1"/>
    <type value="display"/>
    <text value="cancelled as requested"/>
  </processNote>
</ClaimResponse>