eClaims and Preauth APIs
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Endpoints for claim submission and dispatch.
Close an existing claim
POST
https://ilm-dev.dha.go.ke/uat-middleware
/api/v1/claims/close
Closes an existing claim that is not planned to be submitted. Typically used to terminate a claim.
Close an existing claim › Request Body
cancel_reason_textcancel_reason_typeEnum values:
WRONG_PATIENT
NO_SERVICE_GIVEN
WRONG_BENEFIT
EXPIRED_VISIT
EXHAUSTED_BENEFIT
TIME_BARRED
OTHER_REASONS
consent_tokenClose an existing claim › Responses
Claim closed successfully
admitted_onappointment_numberattributesauthorization_codeauthorization_guidbeneficiary_guidbeneficiary_idbeneficiary_is_fuzzy_matchedcancel_reason_textcancel_reason_typeclaim_attachments_countclaim_auth_statusobject[]
claim_idcreated_by_namecurrencydiagnoses_countdischarge_cancel_datedischarge_cancel_remarksdischarge_reasondischarged_onedi_claim_guidemergency_visit_expiryestimate_ip_daysexpected_discharge_datehas_reviewed_claimidinitial_interventionintervention_copay_dataobject[]
invoice_attachments_countinvoice_idinvoice_numberobject[]
is_charge_master_mappedis_negativeis_resubmittedis_zerolast_retrylocation_codelocation_namemember_namemember_numbermember_number_has_tokenmode_of_arrivalnhif_numbernotesnumber_of_invoicespatient_namepatient_numberpayer_codepayer_namepayer_slade_codepolicy_numberpolicy_valid_frompolicy_valid_toprovider_nameprovider_slade_codereason_for_unknown_patientreference_numberresubmission_workflow_stateretry_countscheme_codescheme_nameservice_typetotal_claim_amounttotal_claim_copaytotal_claim_discounttotal_claim_net_amounttotal_claim_splitsupdated_by_namevisit_endvisit_numbervisit_startworkflow_stateDischarge Inpatient
POST
https://ilm-dev.dha.go.ke/uat-middleware
/api/v1/claims/discharge
This API sends a One-Time Password (OTP) to the beneficiary or their next of kin for discharge consent.
Discharge Inpatient › Request Body
consent_tokendischarge_datedischarge_reasonEnum values:
RECOVERED
REFERRED
DECEASED
ABSCONDED
OTHER
invoice_numberotpDischarge Inpatient › Responses
Patient discharged successfully
admitted_onappointment_numberattributesauthorization_codeauthorization_guidbeneficiary_guidbeneficiary_idbeneficiary_is_fuzzy_matchedcancel_reason_textcancel_reason_typeclaim_attachments_countclaim_auth_statusobject[]
claim_idcreated_by_namecurrencydiagnoses_countdischarge_cancel_datedischarge_cancel_remarksdischarge_reasondischarged_onedi_claim_guidemergency_visit_expiryestimate_ip_daysexpected_discharge_datehas_reviewed_claimidinitial_interventionintervention_copay_dataobject[]
invoice_attachments_countinvoice_idinvoice_numberobject[]
is_charge_master_mappedis_negativeis_resubmittedis_zerolast_retrylocation_codelocation_namemember_namemember_numbermember_number_has_tokenmode_of_arrivalnhif_numbernotesnumber_of_invoicespatient_namepatient_numberpayer_codepayer_namepayer_slade_codepolicy_numberpolicy_valid_frompolicy_valid_toprovider_nameprovider_slade_codereason_for_unknown_patientreference_numberresubmission_workflow_stateretry_countscheme_codescheme_nameservice_typetotal_claim_amounttotal_claim_copaytotal_claim_discounttotal_claim_net_amounttotal_claim_splitsupdated_by_namevisit_endvisit_numbervisit_startworkflow_stateSend OTP for Discharge
POST
https://ilm-dev.dha.go.ke/uat-middleware
/api/v1/claims/otp/discharge
This API sends a One-Time Password (OTP) to the beneficiary or their next of kin for discharge consent.
Send OTP for Discharge › Responses
OTP sent successfully
Standard success response format for all successful operations.
object
@Description Response data payload containing operation details @Example {"status": "success"}
message@Description Success message describing the operation result @Example "Visit has been successfully started"
Submit a virtual claim
POST
https://ilm-dev.dha.go.ke/uat-middleware
/api/v1/claims/submit
Finalizes a virtual claim by submitting it for processing and reimbursement. No further changes can be made to the claim after submission.
Submit a virtual claim › Request Body
consent_tokenConsent token for authorization. This is the authorization_code received from the Create Virtual Claim endpoint.
Example: J6LAFNBPZN
invoice_numberUnique invoice number (as used by the provider internally) for the claim being submitted.
Example: INV/5513/70340
reason_for_unknown_patientSubmit a virtual claim › Responses
Claim submitted successfully
admitted_onappointment_numberattributesauthorization_codeauthorization_guidbeneficiary_guidbeneficiary_idbeneficiary_is_fuzzy_matchedcancel_reason_textcancel_reason_typeclaim_attachments_countclaim_auth_statusobject[]
claim_idcreated_by_namecurrencydiagnoses_countdischarge_cancel_datedischarge_cancel_remarksdischarge_reasondischarged_onedi_claim_guidemergency_visit_expiryestimate_ip_daysexpected_discharge_datehas_reviewed_claimidinitial_interventionintervention_copay_dataobject[]
invoice_attachments_countinvoice_idinvoice_numberobject[]
is_charge_master_mappedis_negativeis_resubmittedis_zerolast_retrylocation_codelocation_namemember_namemember_numbermember_number_has_tokenmode_of_arrivalnhif_numbernotesnumber_of_invoicespatient_namepatient_numberpayer_codepayer_namepayer_slade_codepolicy_numberpolicy_valid_frompolicy_valid_toprovider_nameprovider_slade_codereason_for_unknown_patientreference_numberresubmission_workflow_stateretry_countscheme_codescheme_nameservice_typetotal_claim_amounttotal_claim_copaytotal_claim_discounttotal_claim_net_amounttotal_claim_splitsupdated_by_namevisit_endvisit_numbervisit_startworkflow_stateAdd Next of Kin Contact
POST
https://ilm-dev.dha.go.ke/uat-middleware
/api/v1/patients/next-of-kin/contacts
Adds a next of kin contact for a beneficiary.
Add Next of Kin Contact › Request Body
consent_tokencontact_valuenext_of_kin_full_namenext_of_kin_id_numbernext_of_kin_id_number_typeEnum values:
National ID
ClientRegistry ID
Birth Notification
Birth Certificate
Alien ID
Refugee ID
Mandate Number
Temporary ID
Add Next of Kin Contact › Responses
Contact added successfully
activebeneficiarybeneficiaryCodebeneficiaryIdbeneficiaryNamecapturedAtNamecapturedAtSladeCodecontactTypecontactValuedeactivationReasonguididisConfirmedisMainContactisVerifiednextOfKinFullNamenextOfKinIdNumberownerTypeEnum values:
NEXT_OF_KIN
BENEFICIARY
pushedToCrmreplicatedtriggeredByUser