0.1.0 - ci-build
kenyaClaimsIG - Local Development build (v0.1.0) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions
Contents:
This page provides a list of the FHIR artifacts defined as part of this implementation guide.
The following artifacts define the specific capabilities that different types of systems are expected to have in order to comply with this implementation guide. Systems conforming to this implementation guide are expected to declare conformance to one or more of the following capability statements.
| Kenya e-Claims FHIR IG Capability Statement |
Defines the expected capabilities of this IG. |
These define constraints on FHIR resources for systems conforming to this implementation guide.
| AllergyIntoleranceProfile |
A profile for allergy intolerances |
| ClaimAuthorizationInstitutionalProfile |
FHIR Profile for Authorization - Institutional Claim |
| ClaimInstitutionalProfile |
FHIR Profile for Authorization - Institutional Claim |
| ClaimResponse |
This resource provides the adjudication details from the processing of a Claim resource. |
| ClaimResponseAuthorizationResponseProfile |
A response to a request for authorization or preauthorization of products and services. |
| Claims |
Standardise the format of electronic claims / pre-authorizations / pre-determinations. |
| Composition_ke_Profile |
A set of healthcare-related information that is assembled together into a single logical package that provides a single coherent statement of meaning, establishes its own context and that has clinical attestation with regard to who is making the statement. A Composition defines the structure and narrative content necessary for a document. However, a Composition alone does not constitute a document. Rather, the Composition must be the first entry in a Bundle where Bundle.type=document, and any other resources referenced from Composition must be included as subsequent entries in the Bundle (for example Patient, Practitioner, Encounter, etc.). |
| ConditionDiagnosis |
A clinical diagnosis or clinical concept. |
| Condition_Problem_List_ke_Profile |
A clinical problem or other event, situation, issue, or clinical concept that has risen to a level of concern that differs from a diagnosis. |
| DiagnosticReportLabProfile |
A profile for lab diagnostic reports |
| Encounter_ke_Profile |
An interaction between a patient and healthcare provider(s) for the purpose of providing healthcare service(s) or assessing the health status of a patient. |
| ImmunizationProfile |
A record of a patient's immunization. |
| MedicationRequestProfile |
An order or request for both supply of the medication and the instructions for administration of the medication to a patient. The resource is called "MedicationRequest" rather than "MedicationPrescription" or "MedicationOrder" to generalize the use across inpatient and outpatient settings, including care plans, etc., and to harmonize with workflow patterns. |
| MedicationStatementProfile |
A profile for medication statements |
| Medication_ke_Profile |
This resource is primarily used for the identification and definition of a medication for the purposes of prescribing, dispensing, and administering a medication as well as for making statements about medication use. |
| ObservationLabResultsProfile |
A profile for vital signs observations |
| ObservationVitalSignsProfile |
A profile for vital signs observations |
| Observation_ke_Profile |
Measurements and simple assertions made about a patient, device or other subject. |
| PaymentNoticeProfile |
A PaymentNotice resource |
| SHACoverage |
An example of the Coverage resource. |
| SHACoverageEligibilityRequest |
An eligibility request for a patient. |
| SHACoverageEligibilityResponse |
An example of a CoverageEligibilityResponse profile |
| SHAOrganization |
Profile for enrolling a SHA Patient. |
| SHAPatient |
Profile of SHA Patient resource. |
| SHAPractitioner |
Profile for practitioner resource. |
| ServiceRequestImagingProfile |
A profile for imaging service requests. |
| ServiceRequestLabProfile |
A profile for lab service requests. |
| ServiceRequestProcedureProfile |
A profile for procedure service requests. |
| ServiceRequest_ke_Profile |
A record of a request for service such as diagnostic investigations, treatments, or operations to be performed. |
| SpecimenInvestigation |
An investigation of a specimen. |
These define constraints on FHIR data types for systems conforming to this implementation guide.
| AdjudicationOutcome |
A code indicating the outcome of the adjudication such as rejected, partially approved/paid or approved/paid as submitted. |
| Admission Remand Number |
Extension for Admission Remand Number |
| Admission Types |
Admission Types |
| Approved |
Approved |
| Biometrics Score |
Extension for Biometrics Score |
| Biometrics Verified |
Extension for Biometrics Verification |
| Board Registration Number |
Board Registration Number |
| Citizenship |
Extension for Patient's Citizenships |
| ClaimAuthorizationInstitutionalProfileEncounter |
A reference to the encounter |
| ClaimAuthorizationInstitutionalProfileItemDetailTax |
The amount of Tax (VAT) levied on the line item. |
| ClaimAuthorizationInstitutionalProfileItemPatientShare |
Refer to the patient share amount |
| ClaimAuthorizationInstitutionalProfileItemPayerShare |
Refer to the expected payer share amount (to be paid) |
| ClaimAuthorizationInstitutionalProfileItemSubdetailTax |
The amount of Tax (VAT) levied on the line item. |
| ClaimAuthorizationInstitutionalProfileItemTax |
The amount of Tax (VAT) levied on the line item. |
| ClaimAuthorizationInstitutionalProfileTransfer |
A flag to indicate an authorization to transfer services to another provider. |
| Current License Number |
Current License Number |
| Deceased Datetime |
Extension for patient's death Status |
| Disability Category |
Extension for Disability Category |
| Disability Cause |
Extension for Disability Cause |
| Disability Sub-Category |
Extension for Disability Sub-Category |
| EligibilityResponse |
A reference to the coverage eligibility response ID. |
| Employer Name |
Extension for Employer Name |
| Employer Pin |
Extension for Employer Pin |
| ErrorExtensionExpression |
ErrorExtensionExpression |
| Estimated Contribution |
Extension for Estimated Contribution |
| Extension Patient's KRA PIN |
A code representing Patient's KRA PIN |
| Extension for Batch Identifier |
Extension for Batch Identifier |
| Extension for Batch Number |
The number associated with a claim within a Batch. |
| Extension for Batch Period |
The date associated with the Batch.Batch Date |
| Extension for Current License Expiry Date |
Extension for Current License Expiry Date |
| Extension for Current License Number |
Extension for Current License Number |
| Extension for Current License Renewal Date |
Extension for Current License Renewal Date |
| Extension for Current License Type |
Extension for Current License Type |
| Extension for Diagnosis Related Group |
create extension to hold the DRG - Codesystem (AR DRG) and Valueset Required |
| Extension for Eligibility OffLineDate |
Date when the offline check was done |
| Extension for EligibilityOffline |
String will contain a reference value from the payer |
| Extension for Episode |
The provider specific episode identifier. |
| Extension for Facility Registration Number |
Extension for Facility Registration Number |
| Extension for ItemTax |
The amount of Tax (VAT) levied on the line item. |
| Extension for Kenya counties |
A code representing kenya counties |
| Extension for Newborn |
Flag to identify that this claim is for a newborn |
| Extension for Owner Board Registration Number |
Extension for Owner Board Registration Number |
| Extension for Owner Current License Number |
Extension for Owner Current License Number |
| Extension for Owner Id Number |
Extension for Owner Id Number |
| Extension for Package |
A package billing code or bundle code used to group products and services to a particular health condition. |
| Extension for Patient Invoice |
The number of the patient invoice on which the service was billed. |
| Extension for Patient Share |
Refer to the patient share amount |
| Extension for Patient's County |
Patient's County |
| Extension for Patient's Province State Country |
Patient's Province State Country |
| Extension for Patient's Sub-County |
Patient's Patient's Sub-County |
| Extension for Patient's Village Estate |
Patient's Village Estate |
| Extension for Patient's Ward |
Patient's Patient's Ward |
| Extension for Patient's building_house_no |
Patient's building_house_no |
| Extension for Patient's identification residence |
Patient's Identification Residence |
| Extension for Patient's latitude |
Patient's latitude |
| Extension for Patient's longitude |
Patient's longitude |
| Extension for PayerShare |
Refer to the expected payer share amount (to be paid) |
| Extension for Place of Birth |
Place of Birth |
| Extension for Tax |
The amount of Tax (VAT) levied on the line item. |
| Extension for authorization OffLineDate |
Date when the offline check was done |
| Facility Category |
Facility Category/Facility Owner Type |
| Facility Level |
Facility Level |
| Facility Owner |
Facility Owner |
| Facility Type Category |
Facility Type Category |
| Fund |
Fund |
| Gross Income Currency |
Extension for Gross income Currency |
| Gross income |
Extension for Gross income |
| In Lawful Custody |
Extension for In Lawful Custody |
| Is lawful Citizen |
Extension for citizen lawful status |
| License Renewal Duration |
License Renewal Duration |
| Maximum Bed Allocation |
Maximum Bed Allocation |
| Number of Beds |
Number of Beds |
| Number of Cots |
Number of Cots |
| Open Late Night |
Open Late Night |
| Open Public Holiday |
Open Public Holiday |
| Open Weekends |
Open Weekends |
| Open Whole Day |
Open Whole Day |
| Operational Status |
Operational Status |
| PCN |
PCN |
| Parent Facility Code |
Parent Facility Code |
| Patient Employment Type |
Extension for patient's employment type |
| Patient Is Alive |
Extension for patient's alive status |
| PatientPreferredPrimaryCareNetwork |
Extension for patient's preferred primary care network. |
| Person Disability Status |
Extension for person's disability status |
| Physical Address |
Physical Address |
| Practitioner Marital Status |
Practitioner Marital Status |
| Practitioner Specialty |
Practitioner Specialty |
| PriorAuthResponse |
A reference to the prior authorization response ID. |
| Professional Cadre |
Professional Cadre |
| Qualification |
Qualification or Licence |
| Qualification type |
Qualification type |
| Qulaification Institution |
Qualification Institution/Registering Institution |
| Referrer |
Referrer |
| Regulatory Body |
Regulatory Body |
| ReissueReason |
The reason the adjudicator has reissued an authroization or claim response. |
| SiteEligibility |
An extension to indicate whether the patient is eligible or not eligible and why |
| Transfer |
Transfer |
| TransferAuthorizationNumber |
A number assigned to the transfer authorization. |
| TransferAuthorizationPeriod |
A period of time during which the transfer authorization is valid. |
| TransferAuthorizationProvider |
The provider who is authorized to provide the service. |
| constituency |
Constituency |
These define sets of codes used by systems conforming to this implementation guide.
| Claims Response status |
Claims Response status |
| Claims status |
Claims status |
| Code Systems Facility Approval Status |
Code Systems Facility Approval Status |
| Code Systems Facility Category |
Code Systems Facility Category |
| Code Systems Facility Level |
Code Systems Facility Level |
| Code Systems ValueSet |
Code Systems ValueSet |
| Counties in Kenya |
Counties in Kenya |
| Currency ValueSet |
Currency ValueSet |
| Patient Contact Relationship ValueSet |
Patient Contact Relationship ValueSet |
| Patient Employment Type |
Patient Employment Type |
| Patient Identifier Types ValueSet |
Patient Identifier Types ValueSet |
| Patient identifier usage valueSet |
Patient identifier usage valueSet |
| Patient's Citizenship ValueSet |
Patient's Citizenship ValueSet |
| Patient's Marital (Civil) Status |
Patient's Marital (Civil) Status |
| Patient's employment Options |
ValueSet for Patient's employment |
| Practitioner's License Current Renewal Duration |
Practitioner's License Current Renewal Duration |
| Practitioner's Operational Status |
Practitioner's Operational Status |
| Practitioner's Qualifification Type |
Practitioner's Qualifification Type |
| Primary Care Networks |
Primary Care Networks |
| Salutation |
Salutation |
These define new code systems used by systems conforming to this implementation guide.
These are example instances that show what data produced and consumed by systems conforming with this implementation guide might look like.
| ClaimExample |
An example instance of the Claim profile. |
| ClaimResponseExample |
An example instance of the ClaimResponse. |
| ClaimResponseProfileExample |
An example instance of the ClaimResponseProfile. |
| CommunicationRequestExample |
An example instance of the CommunicationRequest. |
| CompositionExample |
An example of the Composition resource. |
| ConditionExample |
An example instance of the Condition profile. |
| DeviceExample |
An example instance of the Device resource. |
| EncounterExample |
An example of the Encounter resource. |
| Example Claim |
An example claim instance for demonstration purposes. |
| Example Health Facility |
An example instance of the Facility profile. |
| Example Practitioner |
An example of the Practitioner resource. |
| Example SHA Patient |
An example SHA patient instance based on the KenyaCorePatient profile. |
| Example SHA Patient |
An example SHA patient instance based on the KenyaCorePatient profile. |
| LocationExample |
An example instance of the Location profile. |
| MedicationExample |
An example of the Medication resource. |
| MedicationRequestExample |
An example of the MedicationRequest resource. |
| MedicationRequestProfileExample |
An example of the MedicationRequestProfile resource. |
| ObservationExample |
An example of the Observation resource. |
| ServiceRequestExample |
An example of the ServiceRequest resource. |