This CapabilityStatement outlines the functional and technical expectations for systems implementing the Kenya eClaims FHIR Implementation Guide, including supported resource interactions, profiles, operations, and system roles.

This profile defines constraints on the Claim resource for use within the Kenya eClaims Implementation Guide. It captures information about a submitted healthcare claim, including details on the patient, provider, services rendered, and associated costs, supporting reimbursement and health insurance processing.

This profile defines constraints on the ClaimResponse resource for use within the Kenya eClaims Implementation Guide. It documents the adjudication results of a submitted claim, including approved amounts, payment information, and reasons for denial or adjustment, facilitating transparent claims settlement.

This profile defines constraints on the Condition resource for use within the Kenya eClaims Implementation Guide. It captures a patient’s clinical diagnosis relevant to an encounter or claim, supporting medical justification, clinical documentation, and claims adjudication.

This profile defines constraints on the DiagnosticReport resource for use within the Kenya eClaims Implementation Guide. It represents the findings and interpretations from laboratory, imaging, or other diagnostic services, supporting clinical decision-making and claim substantiation.

This profile defines constraints on the Encounter resource for use within the Kenya eClaims Implementation Guide. It records interactions between a patient and healthcare provider, including visit type, location, and timing, supporting clinical documentation and claim referencing.

This profile defines constraints on the EpisodeOfCare resource for use within the Kenya eClaims Implementation Guide. It groups related encounters and services delivered to a patient over a defined time period, supporting continuity of care and episode-based claim submissions.

This profile defines constraints on the MedicationDispense resource for use within the Kenya eClaims Implementation Guide. It documents the supply of medication to a patient, including quantity, dosage, and dispensing provider, supporting claim justification and medication traceability.

This profile defines constraints on the MedicationRequest resource for use within the Kenya eClaims Implementation Guide. It represents orders for medications issued to patients, including intent, dosage instructions, and prescribing practitioner, supporting clinical decision-making and claims validation.

This profile defines constraints on the MedicationStatement resource for use within the Kenya eClaims Implementation Guide. It captures information about a patient’s self-reported or documented medication use, supporting medication history review and claims processing.

This profile defines constraints on the Organization resource for use within the Kenya eClaims Implementation Guide. It represents healthcare facilities, insurers, or administrative bodies involved in the delivery or funding of care, supporting identification and affiliation in claims workflows.

This profile defines the minimum required patient demographic and identifier data for submitting standardized health insurance claims within the Kenya eClaims ecosystem.

This profile defines constraints on the PaymentNotice resource for use within the Kenya eClaims Implementation Guide. It provides notice of a payment-related event, such as the issuance or receipt of funds for a healthcare claim, supporting financial reconciliation and tracking.

This profile defines constraints on the Practitioner resource for use within the Kenya eClaims Implementation Guide. It identifies individual healthcare providers involved in patient care and claim-related activities, supporting professional attribution and accountability.

A set of SNOMED CT codes for patient admission sources.

A set of SNOMED CT codes for body sites.

A set of SNOMED CT codes for clinical findings.

A set of SNOMED CT codes for condition severity, including Severe, Moderate, and Mild.

Standard dose forms drawn from the Product Catalogue CodeSystem.

Generic medicinal product definitions used within the product catalogue.

Allowed generic products for medication coding

Standard routes of administration used in the Slade360 ecosystem.

A set of SNOMED CT codes for service types.

Custom units of measure used in the Slade360 ecosystem.

Represents An example Claim instance conforming to the Kenya Claim Profile

Represents An example ClaimResponse instance conforming to the Kenya Claim Profile

A sample malaria condition matching the DiagnosisConditionProfile

An example Condition resource representing a malaria diagnosis.

An example instance of a DiagnosticReport conforming to the DiagnosticReportProfile.

An example encounter for an eClaims patient send to the national HIE

An example instance of the Kenya HIE EpisodeOfCare profile.

An example MedicationRequest for Empagliflozin 5 mg / Metformin 500 mg tablet.

An example instance of a MedicationDispense resource conforming to the MedicationDispense-Profile.

An example instance conforming to the MedicationRequest-Profile.