eClaims and Preauth APIs

Billing

Endpointhttps://ilm-dev.dha.go.ke/uat-middleware/api/v1

Endpoints for billing and invoice management.

Resolve POMSF tariffs (bundle-aware)

POST

https://ilm-dev.dha.go.ke/uat-middleware/api/v1

/benefits/pmf-tariffs/resolve

Forwards the request to the terminology-service bundle-aware POMSF tariff resolver. When HCW identifier details are supplied the practitioner speciality is derived from the health worker registry and normalised to GP|SPECIALIST before forwarding. Requires the feature flag POMSF_RATES_SOURCE=terminology; when it is unset or set to any other value the resolver is disabled and the endpoint returns 501 Not Implemented.

Related documentation: PMF Tariffs Guide

Resolve POMSF tariffs (bundle-aware) › Headers

X-Facility-Id

string

Facility Registry (FR) code identifying the facility. Required when authenticating with a service-account token.

Example: FID-47-115307-8

X-Facility-Id-Type

string

Type of identifier supplied in X-Facility-Id. Currently only fr-code is supported.

Example: fr-code

Resolve POMSF tariffs (bundle-aware) › Request Body

fr_code

string · required

Facility registry code of the facility the tariffs are requested for.

Example: FID-42-110176-7

intervention_codes

string[] · minItems: 1 · required

SHA intervention codes to resolve tariffs for.

Example: ["PMF-12-001"]

as_of

string

Effective date used to resolve tariffs.

Example: 2026-06-08

hcw_identifier

string

Identifier of the health care worker, matching the identifier type. Example is dummy data.

Example: A00000

hcw_identifier_type

string · enum

Type of identifier supplied for the health care worker.

Enum values:

registration_number

National ID

Alien ID

Refugee ID

hcw_puid

hwc_puid

Example: registration_number

hcw_regulator

string · enum

Regulatory body that registered the health care worker.

Enum values:

KMPDC

COC

NCK

PPB

Example: KMPDC

keph_level

string

KEPH level of the facility used to resolve tariffs.

Example: LEVEL 4

scheme

string

Benefit scheme the tariffs are resolved under.

Example: UHC

speciality

string · enum

Practitioner speciality the tariffs apply to.

Enum values:

SPECIALIST

Example: GP

Resolve POMSF tariffs (bundle-aware) › Responses

object

date_uploaded

string

eligible_to_bill

boolean

facility_level

integer

facility_name

string

fr_code

string

has_negotiated_tariff

boolean

object

is_contracted

boolean

speciality

string · enum

Enum values:

SPECIALIST

Example: GP

unmatched_codes

string[]

without_negotiated_rate

string[]

POST/benefits/pmf-tariffs/resolve

curl --request POST \
  --url https://ilm-dev.dha.go.ke/uat-middleware/api/v1/benefits/pmf-tariffs/resolve \
  --header 'Content-Type: application/json' \
  --data '
{
  "as_of": "2026-06-08",
  "fr_code": "FID-42-110176-7",
  "hcw_identifier": "A00000",
  "hcw_identifier_type": "registration_number",
  "hcw_regulator": "KMPDC",
  "intervention_codes": [
    "string"
  ],
  "keph_level": "LEVEL 4",
  "scheme": "UHC",
  "speciality": "GP"
}
'

shell

Example Request Body

{
  "as_of": "2026-06-08",
  "fr_code": "FID-42-110176-7",
  "hcw_identifier": "A00000",
  "hcw_identifier_type": "registration_number",
  "hcw_regulator": "KMPDC",
  "intervention_codes": [
    "string"
  ],
  "keph_level": "LEVEL 4",
  "scheme": "UHC",
  "speciality": "GP"
}

json

Example Responses

{
  "bundles": {},
  "date_uploaded": "date_uploaded",
  "eligible_to_bill": true,
  "facility_level": 0,
  "facility_name": "facility_name",
  "fr_code": "FID-42-110176-7",
  "has_negotiated_tariff": true,
  "interventions": {},
  "is_contracted": true,
  "speciality": "GP",
  "unmatched_codes": [
    "string"
  ],
  "without_negotiated_rate": [
    "string"
  ]
}

json

application/json

Evaluate POMSF rates

POST

https://ilm-dev.dha.go.ke/uat-middleware/api/v1

/benefits/pomsf-rates

Looks up the health care worker in the health worker registry to derive their speciality, then evaluates the published POMSF rates rule set against the provided facility and interventions, returning the parsed tariff entries

Related documentation: PMF Tariffs Guide

Evaluate POMSF rates › Headers

X-Facility-Id

string

Facility Registry (FR) code identifying the facility. Required when authenticating with a service-account token.

Example: FID-47-115307-8

X-Facility-Id-Type

string

Type of identifier supplied in X-Facility-Id. Currently only fr-code is supported.

Example: fr-code

Evaluate POMSF rates › Request Body

fr_code

string · required

Facility registry code of the facility the rates are requested for.

Example: FID-42-110176-7

intervention_codes

string[] · minItems: 1 · required

SHA intervention codes to resolve rates for.

Example: ["PMF-12-001"]

hcw_identifier

string

Identifier of the health care worker, matching the identifier type. Example is dummy data.

Example: A00000

hcw_identifier_type

string · enum

Type of identifier supplied for the health care worker.

Enum values:

registration_number

National ID

Alien ID

Refugee ID

hcw_puid

hwc_puid

Example: registration_number

hcw_regulator

string · enum

Regulatory body that registered the health care worker.

Enum values:

KMPDC

COC

NCK

PPB

Example: KMPDC

Evaluate POMSF rates › Responses

fr_code

string

has_negotiated_rates

boolean

intervention_codes

string[]

is_contracted

boolean

object[]

speciality

string · enum

Enum values:

SPECIALIST

Example: GP

POST/benefits/pomsf-rates

curl --request POST \
  --url https://ilm-dev.dha.go.ke/uat-middleware/api/v1/benefits/pomsf-rates \
  --header 'Content-Type: application/json' \
  --data '
{
  "fr_code": "FID-42-110176-7",
  "hcw_identifier": "A00000",
  "hcw_identifier_type": "registration_number",
  "hcw_regulator": "KMPDC",
  "intervention_codes": [
    "string"
  ]
}
'

shell

Example Request Body

{
  "fr_code": "FID-42-110176-7",
  "hcw_identifier": "A00000",
  "hcw_identifier_type": "registration_number",
  "hcw_regulator": "KMPDC",
  "intervention_codes": [
    "string"
  ]
}

json

Example Responses

{
  "fr_code": "FID-42-110176-7",
  "has_negotiated_rates": true,
  "intervention_codes": [
    "string"
  ],
  "is_contracted": true,
  "results": [
    {
      "facilityName": "facilityName",
      "frCode": "frCode",
      "hasNegotiatedPomsfTariff": true,
      "interventionCode": "interventionCode",
      "interventionName": "interventionName",
      "pomsfDefaultTariff": "pomsfDefaultTariff",
      "pomsfTariff": "pomsfTariff"
    }
  ],
  "speciality": "GP"
}

json

application/json

Add a claim attachment

POST

https://ilm-dev.dha.go.ke/uat-middleware/api/v1

/claims/attachments

Adds a supporting attachment (uploaded file) to an existing virtual claim for a given intervention.

Related documentation: Add Attachment, Adding Attachments Guide

Add a claim attachment › Headers

X-Facility-Id

string

Facility Registry (FR) code identifying the facility. Required when authenticating with a service-account token.

Example: FID-47-115307-8

X-Facility-Id-Type

string

Type of identifier supplied in X-Facility-Id. Currently only fr-code is supported.

Example: fr-code

Add a claim attachment › Request Body

consent_token

string

Authorization code from claim creation. Signifies an authorised claim.

Example: K5HLPJVDNV

file_blob

string

The attachment's binary file content.

document_type

string · enum

Type of the supporting document being attached to the claim.

Enum values:

BIO_DETAILS

BIRTH_NOTIFICATION

CARE_PLAN

CASE_NOTE

CASE_SUMMARY

CERTIFIED_BURIAL_PERMIT

CERTIFIED_COPY_OF_DECEASED_ID

CLAIM_FORM

Example: LAB_RESULTS

intervention_code

string

SHA intervention code the attachment is associated with.

Example: SHA-18-005

Add a claim attachment › Responses

Claim attachment added successfully

attachment

string

attachment_type

string

claim

string

data

string

debug_data

string

description

string

id

string

intervention_code

string

last_retry

string

retry_count

integer

title

string

POST/claims/attachments

curl --request POST \
  --url https://ilm-dev.dha.go.ke/uat-middleware/api/v1/claims/attachments \
  --header 'Content-Type: multipart/form-data' \
  --form consent_token=K5HLPJVDNV \
  --form file_blob=file_blob \
  --form document_type=BIO_DETAILS \
  --form intervention_code=SHA-18-005

shell

Example Request Body

{
  "consent_token": "K5HLPJVDNV",
  "file_blob": "file_blob",
  "document_type": "BIO_DETAILS",
  "intervention_code": "SHA-18-005"
}

json

Example Responses

{
  "attachment": "attachment",
  "attachment_type": "attachment_type",
  "claim": "claim",
  "data": "data",
  "debug_data": "debug_data",
  "description": "description",
  "id": "id",
  "intervention_code": "intervention_code",
  "last_retry": "last_retry",
  "retry_count": 0,
  "title": "title"
}

json

application/json

Remove a claim attachment

PATCH

https://ilm-dev.dha.go.ke/uat-middleware/api/v1

/claims/attachments

Removes a previously uploaded attachment from an existing virtual claim.

Related documentation: Remove Attachment, Adding Attachments Guide

Remove a claim attachment › Headers

X-Facility-Id

string

Facility Registry (FR) code identifying the facility. Required when authenticating with a service-account token.

Example: FID-47-115307-8

X-Facility-Id-Type

string

Type of identifier supplied in X-Facility-Id. Currently only fr-code is supported.

Example: fr-code

Remove a claim attachment › Request Body

Request payload for removing an attachment from a virtual claim.

attachment_id

string · required

Identifier of the attachment to remove from the claim.

Example: 3f2504e0-4f89-41d3-9a0c-0305e82c3301

consent_token

string · required

Patient consent token authorising the change.

Example: K5HLPJVDNV

intervention_code

string · required

SHA intervention code the attachment is linked to.

Example: SHA-18-005

Remove a claim attachment › Responses

Claim attachment removed successfully

Standard success response format for all successful operations.

object

@Description Response data payload containing operation details @Example {"status": "success"}

message

string

@Description Success message describing the operation result @Example "Visit has been successfully started"

PATCH/claims/attachments

curl --request PATCH \
  --url https://ilm-dev.dha.go.ke/uat-middleware/api/v1/claims/attachments \
  --header 'Content-Type: application/json' \
  --data '
{
  "attachment_id": "3f2504e0-4f89-41d3-9a0c-0305e82c3301",
  "consent_token": "K5HLPJVDNV",
  "intervention_code": "SHA-18-005"
}
'

shell

Example Request Body

{
  "attachment_id": "3f2504e0-4f89-41d3-9a0c-0305e82c3301",
  "consent_token": "K5HLPJVDNV",
  "intervention_code": "SHA-18-005"
}

json

Example Responses

{
  "data": {},
  "message": "message"
}

json

application/json

Add a diagnosis to a claim

POST

https://ilm-dev.dha.go.ke/uat-middleware/api/v1

/claims/diagnoses

Adds a diagnosis (ICD code) to an existing virtual claim for a specific intervention.

Related documentation: Add Diagnosis

Add a diagnosis to a claim › Headers

X-Facility-Id

string

Facility Registry (FR) code identifying the facility. Required when authenticating with a service-account token.

Example: FID-47-115307-8

X-Facility-Id-Type

string

Type of identifier supplied in X-Facility-Id. Currently only fr-code is supported.

Example: fr-code

Add a diagnosis to a claim › Request Body

consent_token

string · required

Beneficiary consent token authorizing the diagnosis to be added.

Example: K5HLPJVDNV

icd_code

string · required

ICD-10 diagnosis code being added to the claim or preauthorization.

Example: A09

intervention_code

string · required

SHA intervention (benefit package) code the diagnosis is associated with.

Example: SHA-18-005

practitioner_identification_number

string

Optional. Identification number of the attending practitioner (doctor). Provide the identification number, identification type and regulation body together to attach the doctor to the claim if they were not added before. The same doctor details can be supplied through any of the three endpoints — Create Virtual Claim, Add Diagnosis, or Add Billable Line Item. Example is dummy data.

Example: A00000

practitioner_identification_type

string · enum

Optional. Type of identifier used for the attending practitioner (doctor).

Enum values:

registration_number

National ID

Alien ID

Refugee ID

Example: registration_number

practitioner_regulation_body

string · enum

Enum values:

KMPDC

COC

NCK

PPB

KMPDC

COC

NCK

PPB

Example: KMPDC

Add a diagnosis to a claim › Responses

diagnosis added successfully

claim

string

claim_diagnosis_id

integer

diagnosis

string

diagnosis_code

string

diagnosis_name

string

edi_claim_diagnosis_guid

string

edi_claim_diagnosis_replicated

string

intervention_code

string

is_flagged_diagnosis

boolean

is_inpatient

boolean

original_visit_date

string

patient_number

string

recorded_on

string

site_code

string

site_code_type

string

visit_number

string

POST/claims/diagnoses

curl --request POST \
  --url https://ilm-dev.dha.go.ke/uat-middleware/api/v1/claims/diagnoses \
  --header 'Content-Type: application/json' \
  --data '
{
  "consent_token": "K5HLPJVDNV",
  "icd_code": "A09",
  "intervention_code": "SHA-18-005",
  "practitioner_identification_number": "A00000",
  "practitioner_identification_type": "registration_number",
  "practitioner_regulation_body": "KMPDC"
}
'

shell

Example Request Body

{
  "consent_token": "K5HLPJVDNV",
  "icd_code": "A09",
  "intervention_code": "SHA-18-005",
  "practitioner_identification_number": "A00000",
  "practitioner_identification_type": "registration_number",
  "practitioner_regulation_body": "KMPDC"
}

json

Example Responses

{
  "claim": "claim",
  "claim_diagnosis_id": 0,
  "diagnosis": "diagnosis",
  "diagnosis_code": "diagnosis_code",
  "diagnosis_name": "diagnosis_name",
  "edi_claim_diagnosis_guid": "edi_claim_diagnosis_guid",
  "edi_claim_diagnosis_replicated": "edi_claim_diagnosis_replicated",
  "intervention_code": "intervention_code",
  "is_flagged_diagnosis": true,
  "is_inpatient": true,
  "original_visit_date": "original_visit_date",
  "patient_number": "patient_number",
  "recorded_on": "recorded_on",
  "site_code": "site_code",
  "site_code_type": "site_code_type",
  "visit_number": "visit_number"
}

json

application/json

Remove a claim diagnosis

PATCH

https://ilm-dev.dha.go.ke/uat-middleware/api/v1

/claims/diagnoses

Removes a diagnosis from an existing virtual claim.

Related documentation: Remove Diagnosis

Remove a claim diagnosis › Headers

X-Facility-Id

string

Facility Registry (FR) code identifying the facility. Required when authenticating with a service-account token.

Example: FID-47-115307-8

X-Facility-Id-Type

string

Type of identifier supplied in X-Facility-Id. Currently only fr-code is supported.

Example: fr-code

Remove a claim diagnosis › Request Body

Request payload for removing a diagnosis from a virtual claim.

consent_token

string · required

Patient consent token authorising the change.

Example: K5HLPJVDNV

icd_code

string · required

ICD-10 code of the diagnosis to remove from the claim.

Example: A09

intervention_code

string · required

SHA intervention code the diagnosis is linked to.

Example: SHA-18-005

Remove a claim diagnosis › Responses

Claim diagnosis removed successfully

Standard success response format for all successful operations.

object

@Description Response data payload containing operation details @Example {"status": "success"}

message

string

@Description Success message describing the operation result @Example "Visit has been successfully started"

PATCH/claims/diagnoses

curl --request PATCH \
  --url https://ilm-dev.dha.go.ke/uat-middleware/api/v1/claims/diagnoses \
  --header 'Content-Type: application/json' \
  --data '
{
  "consent_token": "K5HLPJVDNV",
  "icd_code": "A09",
  "intervention_code": "SHA-18-005"
}
'

shell

Example Request Body

{
  "consent_token": "K5HLPJVDNV",
  "icd_code": "A09",
  "intervention_code": "SHA-18-005"
}

json

Example Responses

{
  "data": {},
  "message": "message"
}

json

application/json

Add a billable line item to a claim

POST

https://ilm-dev.dha.go.ke/uat-middleware/api/v1

/claims/lines

Adds a billable line item to an existing virtual claim; accepts a JSON body or multipart form-data. unit_price and quantity are required.

Related documentation: Add a New Line, Add Combined Billing Details, Adding Attachments Guide

Add a billable line item to a claim › Headers

X-Facility-Id

string

Facility Registry (FR) code identifying the facility. Required when authenticating with a service-account token.

Example: FID-47-115307-8

X-Facility-Id-Type

string

Type of identifier supplied in X-Facility-Id. Currently only fr-code is supported.

Example: fr-code

Add a billable line item to a claim › Request Body

oneOf

Exactly one variant must match.

Decision Table

Variant	Matching Criteria
	type = object · requires: consent_token, intervention_code, unit_price +1 more
	type = object · requires: consent_token, intervention_code, unit_price +1 more

Properties for Single Line Item:

Adds a single billable line item to a claim's invoice. Sent as a raw JSON body. Optionally include the attending practitioner's details by supplying the three practitioner fields together.

consent_token

string · required

Authorization code from claim creation. Signifies an authorised claim.

Example: 8EUTW6AQF5

intervention_code

string · required

Intervention code for the service being billed.

Example: SHA-09-021

unit_price

string · required

Unit price of the service. A numeric value sent as a string.

Example: 300

quantity

string · required

Quantity billed. A numeric value sent as a string.

Example: 1

service_name

string

Human-readable name of the service being billed.

Example: Basic consultation

service_identifier

string

Facility's own identifier for the service.

Example: C/123

practitioner_identification_type

string · enum

Optional. Identification type of the attending practitioner (doctor). Supply the three practitioner fields together to attach the doctor's details to the line.

Enum values:

registration_number

National ID

Alien ID

Refugee ID

Example: registration_number

practitioner_identification_number

string

Example: A00000

practitioner_regulation_body

string · enum

Optional. Regulation body the attending practitioner is registered with.

Enum values:

KMPDC

COC

NCK

PPB

Example: KMPDC

Add a billable line item to a claim › Responses

Claim line item added successfully

attributes

string

bill_from

string

bill_to

string

charge_date

string

discount

number

discount_reason

string

doctor_code

string

doctor_name

string

id

string

intervention_code

string

invoice

string

is_active

boolean

is_cancellation

boolean

is_return

boolean

item_code

string

item_name

string

line_copay

number

line_net_amount

number

line_number

string

line_total_amount

number

linked_invoice_line

string

map_request

string

map_request_description

string

mapped_slade_code

string

nhif_rebate_amount

number

patient_discount_amount

number

patient_net_price

number

pmf_line_status

string

quantity

number

scheme_code

string

scheme_name

string

sponsor_net_price

number

uhc_exceeded

boolean

unit

string

unit_price

number

POST/claims/lines

curl --request POST \
  --url https://ilm-dev.dha.go.ke/uat-middleware/api/v1/claims/lines \
  --header 'Content-Type: multipart/form-data' \
  --form consent_token=8EUTW6AQF5 \
  --form intervention_code=SHA-09-021 \
  --form unit_price=300 \
  --form quantity=1 \
  --form 'service_name=Basic consultation' \
  --form service_identifier=C/123 \
  --form practitioner_identification_type=registration_number \
  --form practitioner_identification_number=A00000 \
  --form practitioner_regulation_body=KMPDC

shell

Example Request Body

{
  "consent_token": "8EUTW6AQF5",
  "intervention_code": "SHA-09-021",
  "unit_price": "300",
  "quantity": "1",
  "service_name": "Basic consultation",
  "service_identifier": "C/123",
  "practitioner_identification_type": "registration_number",
  "practitioner_identification_number": "A00000",
  "practitioner_regulation_body": "KMPDC"
}

json

Example Responses

{
  "attributes": "attributes",
  "bill_from": "bill_from",
  "bill_to": "bill_to",
  "charge_date": "charge_date",
  "discount": 0,
  "discount_reason": "discount_reason",
  "doctor_code": "doctor_code",
  "doctor_name": "doctor_name",
  "id": "id",
  "intervention_code": "intervention_code",
  "invoice": "invoice",
  "is_active": true,
  "is_cancellation": true,
  "is_return": true,
  "item_code": "item_code",
  "item_name": "item_name",
  "line_copay": 0,
  "line_net_amount": 0,
  "line_number": "line_number",
  "line_total_amount": 0,
  "linked_invoice_line": "linked_invoice_line",
  "map_request": "map_request",
  "map_request_description": "map_request_description",
  "mapped_slade_code": "mapped_slade_code",
  "nhif_rebate_amount": 0,
  "patient_discount_amount": 0,
  "patient_net_price": 0,
  "pmf_line_status": "pmf_line_status",
  "quantity": 0,
  "scheme_code": "scheme_code",
  "scheme_name": "scheme_name",
  "sponsor_net_price": 0,
  "uhc_exceeded": true,
  "unit": "unit",
  "unit_price": 0
}

json

application/json

Remove a claim line

PATCH

https://ilm-dev.dha.go.ke/uat-middleware/api/v1

/claims/lines

Removes a line item from an existing virtual claim. The line_guid in the request is the id of the line taken from the claim's invoices.lines.

Related documentation: Remove Line

Remove a claim line › Headers

X-Facility-Id

string

Facility Registry (FR) code identifying the facility. Required when authenticating with a service-account token.

Example: FID-47-115307-8

X-Facility-Id-Type

string

Type of identifier supplied in X-Facility-Id. Currently only fr-code is supported.

Example: fr-code

Remove a claim line › Request Body

Request payload for removing a line item from a virtual claim.

consent_token

string · required

Patient consent token authorising the change.

Example: K5HLPJVDNV

line_guid

string · required

GUID of the claim line item to remove.

Example: a1b2c3d4-5678-90ab-cdef-1234567890ab

Remove a claim line › Responses

Claim line removed successfully

Standard success response format for all successful operations.

object

@Description Response data payload containing operation details @Example {"status": "success"}

message

string

@Description Success message describing the operation result @Example "Visit has been successfully started"

PATCH/claims/lines

curl --request PATCH \
  --url https://ilm-dev.dha.go.ke/uat-middleware/api/v1/claims/lines \
  --header 'Content-Type: application/json' \
  --data '
{
  "consent_token": "K5HLPJVDNV",
  "line_guid": "a1b2c3d4-5678-90ab-cdef-1234567890ab"
}
'

shell

Example Request Body

{
  "consent_token": "K5HLPJVDNV",
  "line_guid": "a1b2c3d4-5678-90ab-cdef-1234567890ab"
}

json

Example Responses

{
  "data": {},
  "message": "message"
}

json

application/json

Edit a claim line

PATCH

https://ilm-dev.dha.go.ke/uat-middleware/api/v1

/claims/lines/edit

Edits an existing line item in a virtual claim. Allowed only on RESUBMISSION, and an edit may only adjust an amount DOWNWARD. The line_id in the request is the id of the line taken from the claim's invoices.lines.

Related documentation: Edit Claim Line

Edit a claim line › Headers

X-Facility-Id

string

Facility Registry (FR) code identifying the facility. Required when authenticating with a service-account token.

Example: FID-47-115307-8

X-Facility-Id-Type

string

Type of identifier supplied in X-Facility-Id. Currently only fr-code is supported.

Example: fr-code

Edit a claim line › Request Body

Request payload for editing an existing line item in a virtual claim.

consent_token

string · required

Patient consent token authorising the claim line edit.

Example: K5HLPJVDNV

line_id

string · required

Unique identifier of the claim line item to edit.

Example: a1b2c3d4-5678-90ab-cdef-1234567890ab

quantity

integer

Updated quantity for the claim line item.

Example: 2

unit_price

string

Updated unit price for the claim line item, in KES.

Example: 1500

Edit a claim line › Responses

Claim line edited successfully

attributes

string

bill_from

string

bill_to

string

charge_date

string

discount

number

discount_reason

string

doctor_code

string

doctor_name

string

id

string

intervention_code

string

invoice

string

is_active

boolean

is_cancellation

boolean

is_return

boolean

item_code

string

item_name

string

line_copay

number

line_net_amount

number

line_number

string

line_total_amount

number

linked_invoice_line

string

map_request

string

map_request_description

string

mapped_slade_code

string

nhif_rebate_amount

number

patient_discount_amount

number

patient_net_price

number

pmf_line_status

string

quantity

number

scheme_code

string

scheme_name

string

sponsor_net_price

number

uhc_exceeded

boolean

unit

string

unit_price

number

PATCH/claims/lines/edit

curl --request PATCH \
  --url https://ilm-dev.dha.go.ke/uat-middleware/api/v1/claims/lines/edit \
  --header 'Content-Type: application/json' \
  --data '
{
  "consent_token": "K5HLPJVDNV",
  "line_id": "a1b2c3d4-5678-90ab-cdef-1234567890ab",
  "quantity": 2,
  "unit_price": "1500"
}
'

shell

Example Request Body

{
  "consent_token": "K5HLPJVDNV",
  "line_id": "a1b2c3d4-5678-90ab-cdef-1234567890ab",
  "quantity": 2,
  "unit_price": "1500"
}

json

Example Responses

{
  "attributes": "attributes",
  "bill_from": "bill_from",
  "bill_to": "bill_to",
  "charge_date": "charge_date",
  "discount": 0,
  "discount_reason": "discount_reason",
  "doctor_code": "doctor_code",
  "doctor_name": "doctor_name",
  "id": "id",
  "intervention_code": "intervention_code",
  "invoice": "invoice",
  "is_active": true,
  "is_cancellation": true,
  "is_return": true,
  "item_code": "item_code",
  "item_name": "item_name",
  "line_copay": 0,
  "line_net_amount": 0,
  "line_number": "line_number",
  "line_total_amount": 0,
  "linked_invoice_line": "linked_invoice_line",
  "map_request": "map_request",
  "map_request_description": "map_request_description",
  "mapped_slade_code": "mapped_slade_code",
  "nhif_rebate_amount": 0,
  "patient_discount_amount": 0,
  "patient_net_price": 0,
  "pmf_line_status": "pmf_line_status",
  "quantity": 0,
  "scheme_code": "scheme_code",
  "scheme_name": "scheme_name",
  "sponsor_net_price": 0,
  "uhc_exceeded": true,
  "unit": "unit",
  "unit_price": 0
}

json

application/json

Resubmit a claim line

POST

https://ilm-dev.dha.go.ke/uat-middleware/api/v1

/claims/lines/resubmit

Resubmits a previously rejected or failed claim line so it can be reprocessed.

Related documentation: Resubmit Claim, Claim Resubmission Guide

Resubmit a claim line › Headers

X-Facility-Id

string

Facility Registry (FR) code identifying the facility. Required when authenticating with a service-account token.

Example: FID-47-115307-8

X-Facility-Id-Type

string

Type of identifier supplied in X-Facility-Id. Currently only fr-code is supported.

Example: fr-code

Resubmit a claim line › Request Body

Request payload for resubmitting a claim line that was previously rejected or failed.

consent_token

string · required

Consent token authorising resubmission of the claim line.

Example: K5HLPJVDNV

Resubmit a claim line › Responses

Claim line resubmitted successfully

line_id

string

message

string

resubmitted_at

string

status

string

POST/claims/lines/resubmit

curl --request POST \
  --url https://ilm-dev.dha.go.ke/uat-middleware/api/v1/claims/lines/resubmit \
  --header 'Content-Type: application/json' \
  --data '
{
  "consent_token": "K5HLPJVDNV"
}
'

shell

Example Request Body

{
  "consent_token": "K5HLPJVDNV"
}

json

Example Responses

{
  "line_id": "line_id",
  "message": "message",
  "resubmitted_at": "resubmitted_at",
  "status": "status"
}

json

application/json

Preview a provider claim

POST

https://ilm-dev.dha.go.ke/uat-middleware/api/v1

/claims/preview

Previews the details of a virtual claim as the provider before submission, so the assembled claim can be reviewed.

Related documentation: Preview Provider Claim

Preview a provider claim › Headers

X-Facility-Id

string

Facility Registry (FR) code identifying the facility. Required when authenticating with a service-account token.

Example: FID-47-115307-8

X-Facility-Id-Type

string

Type of identifier supplied in X-Facility-Id. Currently only fr-code is supported.

Example: fr-code

Preview a provider claim › Request Body

Request payload for previewing a virtual claim before submission. Requires consent token.

consent_token

string · required

Consent token from the authorization/visit step, identifying the claim to preview.

Example: K5HLPJVDNV

Preview a provider claim › Responses

Claim preview retrieved successfully

authorization_code

string

object[]

claim_attachments_count

integer

claim_auth_status

string

object[]

created_by_name

string

diagnoses_count

integer

id

string

object[]

invoice_attachments_count

integer

object[]

is_negative

boolean

is_zero

boolean

member_number

string

number_of_invoices

integer

patient_name

string

patient_number

string

provider_name

string

scheme_code

string

scheme_name

string

service_type

string

total_claim_amount

number

total_claim_copay

number

total_claim_discount

number

total_claim_net_amount

number

total_claim_splits

number

visit_end

string

visit_start

string

workflow_state

string

POST/claims/preview

curl --request POST \
  --url https://ilm-dev.dha.go.ke/uat-middleware/api/v1/claims/preview \
  --header 'Content-Type: application/json' \
  --data '
{
  "consent_token": "K5HLPJVDNV"
}
'

shell

Example Request Body

{
  "consent_token": "K5HLPJVDNV"
}

json

Example Responses

{
  "authorization_code": "authorization_code",
  "claim_attachments": [
    {
      "attachment": "attachment",
      "attachment_type": "attachment_type",
      "claim": "claim",
      "data": "data",
      "debug_data": "debug_data",
      "description": "description",
      "id": "id",
      "intervention_code": "intervention_code",
      "last_retry": "last_retry",
      "retry_count": 0,
      "title": "title"
    }
  ],
  "claim_attachments_count": 0,
  "claim_auth_status": "claim_auth_status",
  "claim_diagnoses": [
    {
      "claim": "claim",
      "claim_diagnosis_id": 0,
      "diagnosis": "diagnosis",
      "diagnosis_code": "diagnosis_code",
      "diagnosis_name": "diagnosis_name",
      "edi_claim_diagnosis_guid": "edi_claim_diagnosis_guid",
      "edi_claim_diagnosis_replicated": "edi_claim_diagnosis_replicated",
      "intervention_code": "intervention_code",
      "is_flagged_diagnosis": true,
      "is_inpatient": true,
      "original_visit_date": "original_visit_date",
      "patient_number": "patient_number",
      "recorded_on": "recorded_on",
      "site_code": "site_code",
      "site_code_type": "site_code_type",
      "visit_number": "visit_number"
    }
  ],
  "claim_doctors": [
    {
      "claim": "claim",
      "doctor_name": "doctor_name",
      "id": "id"
    }
  ],
  "created_by_name": "created_by_name",
  "diagnoses_count": 0,
  "id": "id",
  "interventions": [
    {
      "accrued_per_diem_amount": 0,
      "accrued_per_diem_days": 0,
      "active_for_uhc": true,
      "applicable_document_types": [
        "string"
      ],
      "bill_from": "bill_from",
      "bill_to": "bill_to",
      "id": {},
      "intervention_code": "intervention_code",
      "intervention_fund": "intervention_fund",
      "intervention_name": "intervention_name",
      "intervention_overall_tariff": 0,
      "intervention_payment_mechanism": "intervention_payment_mechanism",
      "is_switched_intervention": true,
      "keph_level_tarrif": 0,
      "needs_preauth": true,
      "optional_document_type": [
        "string"
      ],
      "optional_preauth_document_types": [
        "string"
      ],
      "preauth_exist": true,
      "required_preauth_document_types": [
        "string"
      ],
      "requires_oncology_preauth": true,
      "requires_optical_preauth": true,
      "requires_radiology_preauth": true,
      "requires_renal_preauth": true,
      "requires_surgical_preauth": true,
      "sub_benefit_code": "sub_benefit_code",
      "supported_scheme": "supported_scheme",
      "switched_intervention_id": 0,
      "switched_lines_retained": true,
      "workflow_state": "workflow_state"
    }
  ],
  "invoice_attachments_count": 0,
  "invoices": [
    {
      "created_by_name": "created_by_name",
      "department": "department",
      "discount_amount": 0,
      "dispatch_batch_number": "dispatch_batch_number",
      "dispatch_status": "dispatch_status",
      "doctors": [
        {
          "doctor_request_status": "PENDING",
          "slade_code": "slade_code"
        }
      ],
      "edi_invoice_guid": "edi_invoice_guid",
      "edi_invoice_id": 0,
      "id": "id",
      "invoice_date": "invoice_date",
      "invoice_flags": [
        {
          "code": "code",
          "description": "description",
          "edi_flag_guid": "edi_flag_guid",
          "edi_flag_id": 0,
          "existing": "existing",
          "flag_type": "flag_type",
          "invoice": "invoice",
          "is_resolved": true,
          "message": "message",
          "payload": "payload",
          "response": "response",
          "timestamp": "timestamp",
          "traceback": "traceback"
        }
      ],
      "invoice_number": "invoice_number",
      "invoice_type": "invoice_type",
      "lines": [
        {
          "attributes": "attributes",
          "bill_from": "bill_from",
          "bill_to": "bill_to",
          "charge_date": "charge_date",
          "discount": 0,
          "discount_reason": "discount_reason",
          "doctor_code": "doctor_code",
          "doctor_name": "doctor_name",
          "id": "id",
          "intervention_code": "intervention_code",
          "invoice": "invoice",
          "is_active": true,
          "is_cancellation": true,
          "is_return": true,
          "item_code": "item_code",
          "item_name": "item_name",
          "line_copay": 0,
          "line_net_amount": 0,
          "line_number": "line_number",
          "line_total_amount": 0,
          "linked_invoice_line": "linked_invoice_line",
          "map_request": "map_request",
          "map_request_description": "map_request_description",
          "mapped_slade_code": "mapped_slade_code",
          "nhif_rebate_amount": 0,
          "patient_discount_amount": 0,
          "patient_net_price": 0,
          "pmf_line_status": "pmf_line_status",
          "quantity": 0,
          "scheme_code": "scheme_code",
          "scheme_name": "scheme_name",
          "sponsor_net_price": 0,
          "uhc_exceeded": true,
          "unit": "unit",
          "unit_price": 0
        }
      ],
      "linked_invoice": "linked_invoice",
      "linked_invoice_line": "linked_invoice_line",
      "member_name": "member_name",
      "patient_name": "patient_name",
      "patient_number": "patient_number",
      "provider_invoice_ref": "provider_invoice_ref",
      "provider_name": "provider_name",
      "scheme_code": "scheme_code",
      "scheme_name": "scheme_name",
      "scu_branch_id": "scu_branch_id",
      "scu_dispatch_timestamp": "scu_dispatch_timestamp",
      "scu_receipt_signature": "scu_receipt_signature",
      "service_type": "service_type",
      "total_inv_amount": 0,
      "total_inv_copay": 0,
      "total_inv_discount": 0,
      "total_inv_net_amount": 0,
      "visit_end": "visit_end",
      "visit_start": "visit_start",
      "workflow_state": "workflow_state"
    }
  ],
  "is_negative": true,
  "is_zero": true,
  "member_number": "member_number",
  "number_of_invoices": 0,
  "patient_name": "patient_name",
  "patient_number": "patient_number",
  "provider_name": "provider_name",
  "scheme_code": "scheme_code",
  "scheme_name": "scheme_name",
  "service_type": "service_type",
  "total_claim_amount": 0,
  "total_claim_copay": 0,
  "total_claim_discount": 0,
  "total_claim_net_amount": 0,
  "total_claim_splits": 0,
  "visit_end": "visit_end",
  "visit_start": "visit_start",
  "workflow_state": "workflow_state"
}

json

application/json

Preview a payer claim

GET

https://ilm-dev.dha.go.ke/uat-middleware/api/v1

/claims/preview/payer

Previews how a claim will appear to the payer before submission. Identify the claim by its claim invoice guid, or alternatively by its provider_claim_no.

Related documentation: Preview Payer Claim

Preview a payer claim › query Parameters

guid

string · required

Claim invoice guid (alternatively provide provider_claim_no)

Example: 3f2504e0-4f89-41d3-9a0c-0305e82c3301

provider_claim_no

string · required

Provider claim number (alternative to guid)

Example: IP/783/33956

Preview a payer claim › Headers

X-Facility-Id

string

Facility Registry (FR) code identifying the facility. Required when authenticating with a service-account token.

Example: FID-47-115307-8

X-Facility-Id-Type

string

Type of identifier supplied in X-Facility-Id. Currently only fr-code is supported.

Example: fr-code

Preview a payer claim › Responses

Payer claim preview retrieved successfully

pageSize

integer

object[]

GET/claims/preview/payer

curl --request GET \
  --url 'https://ilm-dev.dha.go.ke/uat-middleware/api/v1/claims/preview/payer?guid=%3Cstring%3E&provider_claim_no=%3Cstring%3E'

shell

Example Responses

{
  "pageSize": 0,
  "results": [
    {
      "actualDeductableCopay": 0,
      "authToken": "authToken",
      "authorization": {
        "authCode": "authCode",
        "authorizationReason": "authorizationReason",
        "authorizationType": [
          "string"
        ],
        "beneficiaryCode": "beneficiaryCode",
        "beneficiaryJoinDate": "beneficiaryJoinDate",
        "beneficiaryName": "beneficiaryName",
        "beneficiaryNumber": "beneficiaryNumber",
        "beneficiaryScheme": "beneficiaryScheme",
        "benefitType": "benefitType",
        "created": "created",
        "createdByName": "createdByName",
        "currentAvailableBalance": 0,
        "expiry": "expiry",
        "guid": "guid",
        "id": 0,
        "interventions": [
          {
            "accessPoint": "accessPoint",
            "active": true,
            "annualQuantityLimit": 0,
            "annualQuantityLimitChoice": "annualQuantityLimitChoice",
            "annualQuantityLimitType": "annualQuantityLimitType",
            "applicableDocumentTypes": [
              "string"
            ],
            "applicableFacilityOwnership": "applicableFacilityOwnership",
            "applicableGender": "applicableGender",
            "benefit": 0,
            "code": "code",
            "comment": "comment",
            "complexity": "complexity",
            "coverageLevel": "coverageLevel",
            "diagnosisBlock": [
              "string"
            ],
            "diagnosisList": [
              "string"
            ],
            "guid": "guid",
            "id": 0,
            "investigationTariffHasLimit": true,
            "isIntraMetro": true,
            "kephLevelTarrif": 0,
            "levelsApplicable": [
              "string"
            ],
            "lowerAgeLimit": 0,
            "managementTariffHasLimit": true,
            "name": "name",
            "needApprovalBeforeClaimSubmission": true,
            "needsDoctorAuthorization": true,
            "needsManualPreauthApproval": true,
            "needsMemberAuthorization": true,
            "needsPreauth": true,
            "optionalDocumentType": [
              "string"
            ],
            "optionalPreauthDocumentTypes": [
              "string"
            ],
            "overallTariff": 0,
            "overallTariffHasLimit": true,
            "paymentMechanism": "paymentMechanism",
            "preauthFinalised": true,
            "protocolUsed": "protocolUsed",
            "requiredPreauthDocumentTypes": [
              "string"
            ],
            "requiresOncologyPreauth": true,
            "requiresOpticalPreauth": true,
            "requiresRadiologyPreauth": true,
            "requiresRenalPreauth": true,
            "requiresSurgicalPreauth": true,
            "status": "status",
            "upperAgeLimit": 0,
            "usageFrequencyLimit": 0,
            "usageFrequencyType": "usageFrequencyType"
          }
        ],
        "isComplete": true,
        "isElective": true,
        "isOpen": true,
        "label": "label",
        "needsPreauth": true,
        "notes": "notes",
        "overallPreauthFinalised": true,
        "owner": 0,
        "parentAuthorization": 0,
        "parentPreauth": {
          "accessPoint": "accessPoint",
          "anaesthesiaType": "anaesthesiaType",
          "authorization": 0,
          "authorizationDetails": {
            "authCode": "authCode",
            "authorizationReason": "authorizationReason",
            "authorizationType": [
              "string"
            ],
            "authorizingDeviceOs": "authorizingDeviceOs",
            "beneficiary": 0,
            "beneficiaryCode": "beneficiaryCode",
            "beneficiaryName": "beneficiaryName",
            "beneficiaryNumber": "beneficiaryNumber",
            "beneficiaryScheme": "beneficiaryScheme",
            "benefitType": "benefitType",
            "biometricMatchLogId": "biometricMatchLogId",
            "children": [
              {
                "authorizingDeviceOs": "authorizingDeviceOs",
                "beneficiaryCode": "beneficiaryCode",
                "beneficiaryName": "beneficiaryName",
                "beneficiaryNumber": "beneficiaryNumber",
                "biometricMatchLogId": "biometricMatchLogId",
                "ekycToken": "ekycToken",
                "guid": "guid",
                "interventions": [
                  {
                    "activeForUhc": true,
                    "allowedInterventions": [
                      {}
                    ],
                    "applicableSchemes": [
                      "string"
                    ],
                    "authInterventionId": 0,
                    "code": "code",
                    "dispenseMedication": true,
                    "fallBackKephLevelTariff": 0,
                    "fund": "fund",
                    "id": 0,
                    "interventionCombinations": [
                      {}
                    ],
                    "kephLevelTarrif": 0,
                    "name": "name",
                    "needsPreauth": true,
                    "numberOfDaysToFallback": 0,
                    "overallTariff": 0,
                    "packageCombinations": [
                      {}
                    ],
                    "paymentMechanism": "paymentMechanism",
                    "preauthFinalised": true,
                    "prescriptionMedication": true,
                    "requiresSurgicalPreauth": true,
                    "standaloneInterventions": [
                      {}
                    ],
                    "subBenefitCode": "subBenefitCode",
                    "supportedScheme": "supportedScheme"
                  }
                ],
                "isBiometricsDischargeAuthorization": true,
                "isElective": true,
                "isOpen": true,
                "parentAuthorization": 0,
                "parentType": "parentType",
                "preauthTypes": {},
                "sessionType": "sessionType",
                "shaGuid": "shaGuid",
                "shaVerificationRequestId": "shaVerificationRequestId",
                "status": "status",
                "token": "token",
                "workStationId": "workStationId"
              }
            ],
            "createdByName": "createdByName",
            "dateAuthorized": "dateAuthorized",
            "ekycToken": "ekycToken",
            "electivePreauth": {
              "doctorReviewStatus": "doctorReviewStatus",
              "isElective": true,
              "memberName": "memberName",
              "preauthType": "preauthType",
              "serviceEnd": "serviceEnd",
              "serviceStart": "serviceStart",
              "status": "status"
            },
            "eligibility": "eligibility",
            "eligibilityDetails": {
              "cover": {
                "group": "group",
                "groupCode": "groupCode",
                "jobGroup": "jobGroup",
                "validFrom": "validFrom",
                "validTo": "validTo"
              },
              "member": {
                "age": 0,
                "beneficiaryCode": "beneficiaryCode",
                "gender": "gender",
                "group": "group",
                "idNo": "idNo",
                "idNoType": "idNoType",
                "isAlive": true,
                "isMinor": true,
                "isPrincipal": true,
                "names": "names",
                "principalRelationship": "principalRelationship"
              }
            },
            "endDate": "endDate",
            "endedVia": [
              "string"
            ],
            "expiry": "expiry",
            "guardian": "guardian",
            "guid": "guid",
            "id": 0,
            "interventions": [
              null
            ],
            "isBiometricsDischargeAuthorization": true,
            "isComplete": true,
            "isElective": true,
            "isOpen": true,
            "label": "label",
            "needsPreauth": true,
            "notes": "notes",
            "overallPreauthFinalised": true,
            "parentAuthorization": 0,
            "parentType": "parentType",
            "payerName": "payerName",
            "payerSladeCode": 0,
            "preauthIds": [
              0
            ],
            "preauthTypes": {},
            "provider": 0,
            "providerFid": "providerFid",
            "providerName": "providerName",
            "requestedBy": "requestedBy",
            "sessionType": "sessionType",
            "shaGuid": "shaGuid",
            "shaVerificationRequest": {
              "EmbedExpiry": 0,
              "embededToken": "embededToken",
              "requestId": "requestId",
              "requestUrl": "requestUrl"
            },
            "shaVerificationRequestId": "shaVerificationRequestId",
            "status": "status",
            "token": "token",
            "workStationId": "workStationId"
          },
          "beneficiaryDetails": {
            "DoB": "DoB",
            "beneficiaryCode": "beneficiaryCode",
            "beneficiaryId": 0,
            "categoryCode": "categoryCode",
            "categoryName": "categoryName",
            "firstName": "firstName",
            "gender": "gender",
            "guid": "guid",
            "identifiers": [
              {
                "identifier": "identifier",
                "identifierType": "identifierType"
              }
            ],
            "lastName": "lastName",
            "otherNames": "otherNames",
            "schemeCode": "UHC",
            "schemeName": "schemeName"
          },
          "carcinomaStaging": "carcinomaStaging",
          "clinicalIndications": "clinicalIndications",
          "comorbidity": "comorbidity",
          "conditionCause": "conditionCause",
          "conditionEmploymentRelated": true,
          "conditionOtherRelated": true,
          "costPerSession": "costPerSession",
          "countdown": 0,
          "createdByName": "createdByName",
          "description": "description",
          "doctorApproved": true,
          "doctorReviewStatus": "doctorReviewStatus",
          "finalApprovedAmount": 0,
          "guid": "guid",
          "id": 0,
          "interventionCode": "interventionCode",
          "interventionData": {
            "code": "code",
            "fallBackKephLevelTariff": 0,
            "guid": "guid",
            "id": 0,
            "kephLevelTarrif": 0,
            "name": "name",
            "numberOfDaysToFallback": 0,
            "overallTariff": 0,
            "paymentMechanism": "paymentMechanism",
            "status": "status"
          },
          "isElective": true,
          "isEmergency": true,
          "isHmisPreauth": true,
          "isOncology": true,
          "isOptical": true,
          "isRadiology": true,
          "isRenal": true,
          "isRequestPhase": true,
          "isResponsePhase": true,
          "isSurgical": true,
          "lengthOfStay": 0,
          "memberIdentifier": "memberIdentifier",
          "memberIsVip": true,
          "memberIsVvip": true,
          "memberName": "memberName",
          "memberScheme": "memberScheme",
          "metastases": "metastases",
          "needsDoctorApproval": true,
          "numberOfPreauthDoctorsRequired": 0,
          "otherMetastases": "otherMetastases",
          "payerIdentifier": "payerIdentifier",
          "payerInvoiceNo": "payerInvoiceNo",
          "payerName": "payerName",
          "preauthAttachments": [
            {
              "attachment": 0,
              "attachmentType": "BIOPSY_RESULT",
              "author": "author",
              "authorEmail": "authorEmail",
              "authorName": "authorName",
              "contentType": "contentType",
              "description": "description",
              "guid": "guid",
              "id": 0,
              "interventionCode": "interventionCode",
              "organisationName": "organisationName",
              "source": "source",
              "title": "title",
              "uploadedFile": "uploadedFile"
            }
          ],
          "preauthDiagnoses": [
            {
              "authorizationIntervention": "authorizationIntervention",
              "description": "description",
              "guid": "guid",
              "id": 0,
              "interventionCode": "interventionCode",
              "interventionName": "interventionName",
              "name": "name",
              "preauthDiagnosisType": "preauthDiagnosisType",
              "requestedBy": "requestedBy",
              "requestedByName": "requestedByName",
              "requestedOn": "requestedOn",
              "respondedBy": "respondedBy",
              "respondedByName": "respondedByName",
              "respondedOn": "respondedOn",
              "responseNote": "responseNote",
              "siteCode": "siteCode",
              "siteCodeType": "siteCodeType",
              "status": "status"
            }
          ],
          "preauthDoctors": [
            {
              "doctorProfile": {
                "active": true,
                "contacts": [
                  {
                    "active": true,
                    "businessPartner": {},
                    "canSendComm": true,
                    "contactName": "contactName",
                    "contactType": "contactType",
                    "contactValue": "contactValue",
                    "deactivationReason": "deactivationReason",
                    "guid": "guid",
                    "id": 0,
                    "isConfirmed": true,
                    "role": "role"
                  }
                ],
                "country": "country",
                "currencyCode": "currencyCode",
                "guid": "guid",
                "id": 0,
                "identifiers": [
                  null
                ],
                "name": "name",
                "nationalIdentifier": "nationalIdentifier",
                "practitionerCadre": "practitionerCadre",
                "practitionerDisciplineName": "practitionerDisciplineName",
                "practitionerGender": "practitionerGender",
                "practitionerIdNumber": "practitionerIdNumber",
                "practitionerIdType": "practitionerIdType",
                "practitionerInHealthWorkerRegistry": true,
                "practitionerLicenceNumber": "practitionerLicenceNumber",
                "practitionerLicenceStart": "practitionerLicenceStart",
                "practitionerLicenceType": "practitionerLicenceType",
                "practitionerLicenceValidity": "practitionerLicenceValidity",
                "practitionerLicenseBody": "practitionerLicenseBody",
                "practitionerLicenseStatus": "practitionerLicenseStatus",
                "practitionerPostalAddress": "practitionerPostalAddress",
                "practitionerQualifications": "practitionerQualifications",
                "practitionerRegistrationNumber": "practitionerRegistrationNumber",
                "practitionerRegistryId": "practitionerRegistryId",
                "practitionerSpecialty": "practitionerSpecialty",
                "practitionerSubSpecialty": "practitionerSubSpecialty",
                "practitionerType": "practitionerType",
                "sladeCode": 0,
                "specialty": [
                  "string"
                ],
                "suspended": true,
                "suspensionReason": "suspensionReason"
              },
              "doctorReviewStatus": "doctorReviewStatus",
              "doctorType": "doctorType",
              "guid": "guid",
              "hospitalDoctorName": "hospitalDoctorName",
              "id": 0,
              "isHospitalDoctor": true,
              "name": "name",
              "notes": "notes",
              "requestedBy": "requestedBy",
              "requestedByName": "requestedByName",
              "requestedOn": "requestedOn",
              "respondedBy": "respondedBy",
              "respondedByName": "respondedByName",
              "respondedOn": "respondedOn",
              "responseNote": "responseNote",
              "sladeCode": 0,
              "status": "status"
            }
          ],
          "preauthFlags": [
            {}
          ],
          "preauthItems": [
            {
              "approvedAmount": 0,
              "approvedBy": "approvedBy",
              "approvedByName": "approvedByName",
              "approvedQuantity": "approvedQuantity",
              "approvedUnitPrice": 0,
              "category": "category",
              "chargeDate": "chargeDate",
              "cmCode": "cmCode",
              "description": "description",
              "estimatedAmount": 0,
              "guid": "guid",
              "id": 0,
              "intervention": "intervention",
              "interventionCode": "interventionCode",
              "interventionName": "interventionName",
              "name": "name",
              "payerInvoiceLineNo": "payerInvoiceLineNo",
              "providerCurrency": "providerCurrency",
              "quantity": "quantity",
              "requestedBy": "requestedBy",
              "requestedByName": "requestedByName",
              "requestedOn": "requestedOn",
              "respondedBy": "respondedBy",
              "respondedByName": "respondedByName",
              "respondedOn": "respondedOn",
              "responseNote": "responseNote",
              "schemeName": "schemeName",
              "status": "status",
              "unitPrice": 0
            }
          ],
          "preauthNotes": [
            {
              "author": "author",
              "authorEmail": "authorEmail",
              "authorName": "authorName",
              "guid": "guid",
              "id": 0,
              "note": "note",
              "organisationName": "organisationName",
              "source": "source"
            }
          ],
          "preauthType": "preauthType",
          "providerConsent": true,
          "providerCurrency": "providerCurrency",
          "providerDetails": {
            "active": true,
            "bpLevel": "bpLevel",
            "businessPartnerId": 0,
            "guid": "guid",
            "identifiers": [
              null
            ],
            "name": "name",
            "nationalIdentifier": "nationalIdentifier",
            "sladeCode": 0
          },
          "providerName": "providerName",
          "providerNotificationEmail": "providerNotificationEmail",
          "reasonForAcuteDialysis": "reasonForAcuteDialysis",
          "reasonForSelectingOther": "reasonForSelectingOther",
          "requestExtraData": {
            "anaesthesiaType": "anaesthesiaType",
            "carcinomaStaging": "STAGE_1",
            "chiefComplaint": "chiefComplaint",
            "clinicalIndications": "clinicalIndications",
            "coinsuranceDetails": "coinsuranceDetails",
            "comorbidity": "comorbidity",
            "conditionEmploymentRelated": true,
            "conditionOtherRelated": true,
            "consultationDescription": "consultationDescription",
            "costPerSession": 0,
            "eyeExaminationAmount": 0,
            "eyeExaminationDescription": "eyeExaminationDescription",
            "frameAmount": 0,
            "frameDescription": "frameDescription",
            "hasCoinsurance": true,
            "hpi": "hpi",
            "investigations": "investigations",
            "lensAmount": 0,
            "lensDescription": "lensDescription",
            "lensPrescription": "lensPrescription",
            "metastases": [
              "LUNG"
            ],
            "physicalExamination": "physicalExamination",
            "progressReport": "progressReport",
            "reasonForService": "reasonForService",
            "replacement": "replacement",
            "sessionExpectedDate": "sessionExpectedDate",
            "sessionsFrequency": "sessionsFrequency",
            "sessionsRequired": 0,
            "subType": "subType",
            "treatmentSetting": [
              "DAY_WARD"
            ],
            "vitalSigns": "vitalSigns"
          },
          "responseExtraData": {
            "finalizeNote": "finalizeNote"
          },
          "serviceEnd": "serviceEnd",
          "serviceStart": "serviceStart",
          "sessionExpectedDate": "sessionExpectedDate",
          "sessionType": "sessionType",
          "sessionsFrequency": "sessionsFrequency",
          "sessionsRequired": 0,
          "status": "status",
          "submissionDateIn_EAT": "submissionDateIn_EAT",
          "token": "token",
          "totalEstimatedAmountForPreauth": 0,
          "totalInterimApprovedAmountForPreauth": 0,
          "updatedByName": "updatedByName"
        },
        "parentType": "parentType",
        "policyEffectiveDate": "policyEffectiveDate",
        "preauthIds": [
          0
        ],
        "providerName": "providerName",
        "requestedBy": "requestedBy",
        "sessionType": "sessionType",
        "status": "status",
        "token": "token",
        "totalAuthorizedAmount": 0
      },
      "billFrom": "billFrom",
      "billTo": "billTo",
      "claimAttachments": [
        {
          "attachment": "attachment",
          "attachment_type": "attachment_type",
          "claim": "claim",
          "data": "data",
          "debug_data": "debug_data",
          "description": "description",
          "id": "id",
          "intervention_code": "intervention_code",
          "last_retry": "last_retry",
          "retry_count": 0,
          "title": "title"
        }
      ],
      "claimDoctors": [
        {
          "doctorProfile": {
            "practitionerCadre": "practitionerCadre",
            "practitionerGender": "practitionerGender",
            "practitionerLicenceNumber": "practitionerLicenceNumber",
            "practitionerLicenceValidity": "practitionerLicenceValidity",
            "practitionerLicenseBody": "practitionerLicenseBody",
            "practitionerQualifications": "practitionerQualifications",
            "practitionerRegistrationNumber": "practitionerRegistrationNumber",
            "practitionerRegistryId": "practitionerRegistryId"
          },
          "name": "name"
        }
      ],
      "claimFlags": [
        {
          "code": "code",
          "description": "description",
          "flagType": "flagType",
          "guid": "guid",
          "id": 0,
          "isResolved": true,
          "message": "message",
          "workflowState": "workflowState"
        }
      ],
      "claimLines": [
        {
          "approvedLineTotal": 0,
          "billFrom": "billFrom",
          "billTo": "billTo",
          "billingCode": "billingCode",
          "chargeDate": "chargeDate",
          "claimLineGrossTotal": 0,
          "claimLineTotal": 0,
          "guid": "guid",
          "id": 0,
          "intervention": 0,
          "interventionCode": "interventionCode",
          "interventionName": "interventionName",
          "name": "name",
          "providerClaimLineNo": "providerClaimLineNo",
          "quantity": 0,
          "rejectedLineTotal": 0,
          "schemeCode": "schemeCode",
          "schemeName": "schemeName",
          "unit": "unit",
          "unitPrice": 0,
          "workflowState": "workflowState"
        }
      ],
      "claimNotes": [
        {
          "author": "author",
          "guid": "guid",
          "id": 0,
          "note": "note",
          "source": "source",
          "workflowState": "workflowState"
        }
      ],
      "claimTransitions": [
        {
          "guid": "guid",
          "id": 0,
          "transitionDate": "transitionDate",
          "workflowStateFrom": "workflowStateFrom",
          "workflowStateTo": "workflowStateTo"
        }
      ],
      "claimType": "claimType",
      "created": "created",
      "diagnoses": [
        {
          "encounter": 0,
          "encounterGuid": "encounterGuid",
          "guid": "guid",
          "intervention": 0,
          "name": "name",
          "siteCode": "siteCode",
          "siteCodeType": "siteCodeType"
        }
      ],
      "encounter": 0,
      "guid": "guid",
      "id": 0,
      "isCreditNote": true,
      "isInpatient": true,
      "memberName": "memberName",
      "memberNumber": "memberNumber",
      "owner": 0,
      "proposedValue": 0,
      "proposedValueLessCopays": 0,
      "providerClaimNo": "providerClaimNo",
      "providerName": "providerName",
      "schemeName": "schemeName",
      "totalCopayValue": 0,
      "trackingNumber": "trackingNumber",
      "workflowDisplayName": "workflowDisplayName",
      "workflowState": "workflowState"
    }
  ]
}

json

application/json

Upload a file

POST

https://ilm-dev.dha.go.ke/uat-middleware/api/v1

/uploads

Uploads a file and returns its storage identifier together with presigned URLs for inline preview and save-as download.

Upload a file › Headers

X-Facility-Id

string

Facility Registry (FR) code identifying the facility. Required when authenticating with a service-account token.

Example: FID-47-115307-8

X-Facility-Id-Type

string

Type of identifier supplied in X-Facility-Id. Currently only fr-code is supported.

Example: fr-code

Upload a file › Request Body

file

string

Upload a file › Responses

File stored successfully

download_url

string

expires_in_seconds

integer

file_id

string

preview_url

string

POST/uploads

curl --request POST \
  --url https://ilm-dev.dha.go.ke/uat-middleware/api/v1/uploads \
  --header 'Content-Type: multipart/form-data' \
  --form file=file

shell

Example Request Body

{
  "file": "file"
}

json

Example Responses

{
  "download_url": "download_url",
  "expires_in_seconds": 0,
  "file_id": "file_id",
  "preview_url": "preview_url"
}

json

application/json

Get file download URL

GET

https://ilm-dev.dha.go.ke/uat-middleware/api/v1

/uploads/{file_id}

Generates a pre-signed download URL for a previously uploaded file.

Get file download URL › path Parameters

file_id

string · required

File ID returned when the file was uploaded

Example: 3f2504e0-4f89-41d3-9a0c-0305e82c3301

Get file download URL › Headers

X-Facility-Id

string

Facility Registry (FR) code identifying the facility. Required when authenticating with a service-account token.

Example: FID-47-115307-8

X-Facility-Id-Type

string

Type of identifier supplied in X-Facility-Id. Currently only fr-code is supported.

Example: fr-code

Get file download URL › Responses

Pre-signed URL generated successfully

Standard success response format for all successful operations.

object

@Description Response data payload containing operation details @Example {"status": "success"}

message

string

@Description Success message describing the operation result @Example "Visit has been successfully started"

GET/uploads/{file_id}

curl --request GET \
  --url https://ilm-dev.dha.go.ke/uat-middleware/api/v1/uploads/:file_id

shell

Example Responses

{
  "data": {},
  "message": "message"
}

json

application/json

Preauths Preauth Doctor Consent