Kenya eClaims FHIR Implementation Guide
0.1.0 - ci-build KE

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

Table of Contents

.. 0 Table of Contents
... 1 Home
... 2 Background
... 3 Use Cases
... 4 Actors & Transactions
... 5 Security & Privacy
... 6 Conformance Requirements
... 7 Terminology Guidance
... 8 Downloads & Validation
... 9 Artifacts Summary
.... 9.1 Claim Response - Preauthorization
.... 9.2 Claim Submission
.... 9.3 Coverage Profile
.... 9.4 eClaims Condition/Diagnosis Profile
.... 9.5 eClaims Diagnostic Report Profile
.... 9.6 eClaims Encounter Profile
.... 9.7 eClaims Episode of Care Profile
.... 9.8 eClaims Medication Dispense Profile
.... 9.9 eClaims Medication Request Profile
.... 9.10 eClaims Medication Statement Profile
.... 9.11 eClaims Organization Profile
.... 9.12 eClaims Patient Profile
.... 9.13 eClaims Payment Notice Profile
.... 9.14 eClaims Practitioner Profile
.... 9.15 Imaging Preauthorization
.... 9.16 Kenya eClaims Base Profile
.... 9.17 Kenya eClaims ClaimResponse Profile
.... 9.18 Oncology Preauthorization
.... 9.19 Optical Preauthorization
.... 9.20 Renal Preauthorization
.... 9.21 Surgical Preauthorization
.... 9.22 Anaesthesia Type
.... 9.23 Annual Limits Category Extension
.... 9.24 Attachment Type
.... 9.25 Carcinoma Staging
.... 9.26 Chief Complaint
.... 9.27 Claim Workflow State
.... 9.28 Clinical Indications
.... 9.29 Consultation Amount
.... 9.30 Cost Per Session
.... 9.31 Current member status Extension
.... 9.32 Exclusion Extension
.... 9.33 Eye Examination Amount
.... 9.34 Frame Amount
.... 9.35 Has Coinsurance
.... 9.36 History of Present Illness
.... 9.37 Investigations
.... 9.38 Item Coverage Reference
.... 9.39 Last Replacement Date
.... 9.40 Lens Amount
.... 9.41 Lens Prescription
.... 9.42 Metastases
.... 9.43 Other Metastases
.... 9.44 Patient Invoice Details
.... 9.45 Paymen tMethod Extension
.... 9.46 Physical Examination
.... 9.47 Plan Type Extension
.... 9.48 Preauthorization Expiry Date
.... 9.49 Preauthorization Expiry Date
.... 9.50 Preauthorization Expiry Date
.... 9.51 Preauthorization Token
.... 9.52 Provider Auth Token
.... 9.53 Raw Preauth Source Data
.... 9.54 Reason For Service
.... 9.55 Replacement Type
.... 9.56 Session Expected Date
.... 9.57 Treatment Setting
.... 9.58 Vital Signs
.... 9.59 Address Use ValueSet
.... 9.60 Administration Method ValueSet
.... 9.61 Administrative Gender ValueSet
.... 9.62 As Needed Reason ValueSet
.... 9.63 Attachment Type ValueSet
.... 9.64 Civil Status ValueSet
.... 9.65 Claim Care Team Role ValueSet
.... 9.66 Claim Diagnosis ValueSet
.... 9.67 Claim Status ValueSet
.... 9.68 Claim Subtype ValueSet
.... 9.69 Claim Type ValueSet
.... 9.70 Claim Use ValueSet
.... 9.71 Condition Category ValueSet
.... 9.72 Condition Clinical Status ValueSet
.... 9.73 Condition Codes ValueSet
.... 9.74 Condition Severity ValueSet
.... 9.75 Condition Verification Status ValueSet
.... 9.76 Contact Point System ValueSet
.... 9.77 Contact Point Use ValueSet
.... 9.78 Coverage Class ValueSet
.... 9.79 Coverage Exclusion Reason ValueSet
.... 9.80 Coverage Member Status ValueSet
.... 9.81 Coverage Plan Type ValueSet
.... 9.82 Coverage Type ValueSet
.... 9.83 Dosage Additional Instruction ValueSet
.... 9.84 Encounter Status ValueSet
.... 9.85 Episode of Care Status ValueSet
.... 9.86 Episode of Care Type ValueSet
.... 9.87 Gender ValueSet
.... 9.88 Generic Products ValueSet
.... 9.89 Identifier Types ValueSet
.... 9.90 Identifier Use ValueSet
.... 9.91 Kenya Institutional Body Site ValueSet
.... 9.92 Kenya Social Health Authority Interventions ValueSet
.... 9.93 Kenya Subsite ValueSet
.... 9.94 Medication Status Reason ValueSet
.... 9.95 Name Use ValueSet
.... 9.96 Payment Method ValueSet
.... 9.97 Preauthorization Exclusion Reason ValueSet
.... 9.98 Related Claim Relationship ValueSet
.... 9.99 Waiver Type ValueSet
.... 9.100 Address Use Code System
.... 9.101 Administration Method Code System
.... 9.102 Administrative Gender Code System
.... 9.103 As Needed Reason Code System
.... 9.104 Attachment Type Code System
.... 9.105 BodySite Code System
.... 9.106 Civil Status Code System
.... 9.107 Claim Care Team Role Code System
.... 9.108 Claim Expiry Code System
.... 9.109 Claim State Code System
.... 9.110 Claim Status Code System
.... 9.111 Claim Subtype Code System
.... 9.112 Claim Type Code System
.... 9.113 Claim Use Code System
.... 9.114 Condition Category Code System
.... 9.115 Condition Category Code System
.... 9.116 Condition Clinical Status Code System
.... 9.117 Condition Codes Code System
.... 9.118 Condition Severity Code System
.... 9.119 Condition Verification Status Code System
.... 9.120 Contact Point System Code System
.... 9.121 Contact Point Use Code System
.... 9.122 Coverage Class Code System
.... 9.123 Coverage Member Status Code System
.... 9.124 Coverage Plan Type Code System
.... 9.125 Coverage Type Code System
.... 9.126 Dosage Additional Instruction Code System
.... 9.127 Encounter Status Code System
.... 9.128 Episode of Care Status Code System
.... 9.129 Episode of Care Type Code System
.... 9.130 Exclusion Code System
.... 9.131 Gender Code System
.... 9.132 Generic Products Code System
.... 9.133 Identifier Types Code System
.... 9.134 Identifier Use Code System
.... 9.135 Medication Status Reason Code System
.... 9.136 Name Use Code System
.... 9.137 Payment Method Code System
.... 9.138 PreAuthExclusions Code System
.... 9.139 Related Claim Relationship Code System
.... 9.140 Subsite Code System
.... 9.141 Subsite Code System
.... 9.142 Waiver Type Code System
.... 9.143 Example Claim for ClaimResponse (canceled)
.... 9.144 Example Claim for ClaimResponse (sent-back)
.... 9.145 Example Claim Response
.... 9.146 Example ClaimResponse - Canceled
.... 9.147 Example ClaimResponse - Sent Back
.... 9.148 Example Coverage
.... 9.149 Example Insurer Organization
.... 9.150 Example Location
.... 9.151 Example Medication Request
.... 9.152 Example Patient
.... 9.153 Example Patient (generic)
.... 9.154 Example Practitioner
.... 9.155 Example Provider Organization
.... 9.156 Example Related Claim
.... 9.157 Example Service Request
.... 9.158 Social Health Authority