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Source1

{
  "resourceType": "CodeSystem",
  "id": "payer-benefit-codesystem",
  "text": {
    "status": "generated",
    "div": "<!-- snip (see above) -->"
  },
  "url": "https://fhir.slade360.co.ke/fhir/CodeSystem/payer-benefit-codesystem",
  "version": "0.1.0",
  "name": "SGHIPayerBenefitCodeSystem",
  "title": "SGHI Payer Benefit Code System",
  "status": "active",
  "experimental": false,
  "date": "2026-10-02T07:33:51+00:00",
  "publisher": "Kathurima Kimathi",
  "contact": [
    {
      "name": "Kathurima Kimathi",
      "telecom": [
        {
          "system": "url",
          "value": "https://www.linkedin.com/in/kathurima-kimathi/"
        },
        {
          "system": "email",
          "value": "kathurimakimathi415@gmail.com"
        }
      ]
    },
    {
      "name": "Oscar John",
      "telecom": [
        {
          "system": "email",
          "value": "oscarjohnotieno@gmail.com",
          "use": "work"
        }
      ]
    },
    {
      "name": "Kennedy Omondi",
      "telecom": [
        {
          "system": "email",
          "value": "kennankole@gmail.com",
          "use": "work"
        }
      ]
    }
  ],
  "description": "Payer schemes, benefit packages, tariff rules and the Social Health Authority intervention codes read when admitting an insured patient.",
  "caseSensitive": true,
  "content": "complete",
  "count": 12,
  "property": [
    {
      "code": "requires-preauthorisation",
      "uri": "https://fhir.slade360.co.ke/fhir/concept-properties#requires-preauthorisation",
      "description": "True where the payer requires pre-authorisation before the intervention is delivered.",
      "type": "boolean"
    },
    {
      "code": "emergency-benefit",
      "uri": "https://fhir.slade360.co.ke/fhir/concept-properties#emergency-benefit",
      "description": "True where the intervention is funded from the emergency fund rather than a benefit package.",
      "type": "boolean"
    }
  ],
  "concept": [
    {
      "code": "sha",
      "display": "Social Health Authority",
      "definition": "A public scheme capped in bed-days per household per year, pooled across the household."
    },
    {
      "code": "private",
      "display": "Private insurance",
      "definition": "A private scheme capped in shillings."
    },
    {
      "code": "benefit-inpatient",
      "display": "Inpatient management",
      "definition": "The SHA inpatient benefit package."
    },
    {
      "code": "benefit-corporate-inpatient",
      "display": "Corporate inpatient",
      "definition": "A private corporate inpatient benefit package."
    },
    {
      "code": "per-night",
      "display": "Per night",
      "definition": "The tariff is claimed for each night of stay."
    },
    {
      "code": "per-episode",
      "display": "Per episode",
      "definition": "The tariff is claimed once for the episode."
    },
    {
      "code": "SHA-IP-MED-01",
      "display": "Medical inpatient management",
      "definition": "General medical inpatient management, claimed per night.",
      "property": [
        {
          "code": "requires-preauthorisation",
          "valueBoolean": true
        },
        {
          "code": "emergency-benefit",
          "valueBoolean": false
        }
      ]
    },
    {
      "code": "SHA-IP-HDU-02",
      "display": "High dependency care",
      "definition": "High dependency inpatient care, claimed per night.",
      "property": [
        {
          "code": "requires-preauthorisation",
          "valueBoolean": true
        },
        {
          "code": "emergency-benefit",
          "valueBoolean": false
        }
      ]
    },
    {
      "code": "SHA-MAT-ND-01",
      "display": "Normal delivery",
      "definition": "Normal delivery, claimed per episode.",
      "property": [
        {
          "code": "requires-preauthorisation",
          "valueBoolean": false
        },
        {
          "code": "emergency-benefit",
          "valueBoolean": false
        }
      ]
    },
    {
      "code": "SHA-MAT-CS-02",
      "display": "Caesarean section",
      "definition": "Caesarean section, claimed per episode.",
      "property": [
        {
          "code": "requires-preauthorisation",
          "valueBoolean": true
        },
        {
          "code": "emergency-benefit",
          "valueBoolean": false
        }
      ]
    },
    {
      "code": "SHA-EMC-STB-01",
      "display": "Emergency stabilisation and treatment",
      "definition": "Emergency stabilisation, claimed per episode from the emergency fund.",
      "property": [
        {
          "code": "requires-preauthorisation",
          "valueBoolean": false
        },
        {
          "code": "emergency-benefit",
          "valueBoolean": true
        }
      ]
    },
    {
      "code": "SHA-EMC-CRIT-02",
      "display": "Emergency critical care, first 24 hours",
      "definition": "Emergency critical care for the first 24 hours, claimed per night from the emergency fund.",
      "property": [
        {
          "code": "requires-preauthorisation",
          "valueBoolean": false
        },
        {
          "code": "emergency-benefit",
          "valueBoolean": true
        }
      ]
    }
  ]
}