II. E-Klaim
Last Updated: 2023/09/17
Step 1. Konversi format data E-Klaim ke format FHIR
Sama seperti proses yang sudah berlangsung sebelumnya, pengajuan klaim oleh fasyankes tetap dilakukan melalui aplikasi E-Klaim. Aplikasi E-Klaim inilah yang nantinya akan melakukan konversi data klaim ke format FHIR (resource *Claim*) dan dikirimkan ke SATUSEHAT.
Resource *Claim* disini akan referensi ke data klinis seperti *Encounter*, *Observation*, dan data pendukung lainnya. Berhubung fasyankes diperbolehkan untuk melakukan pengajuan klaim terhadap beberapa kunjungan pasien secara sekaligus, maka dari itu 1 *Claim* (1 Nomor SEP) bisa mencakup lebih dari 1 data kunjungan pasien (resource *Encounter*).
Klaim BPJS INACBG
{ "resourceType": "Claim", "id": "960151", "meta": { "profile": [ "https://fhir.kemkes.go.id/r4/StructureDefinition/Claim" ] }, "identifier": [ { "system": "http://sys-ids.kemkes.go.id/jkn-claim-batch-number", "value": "96123451" } ], "status": "active", "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/claim-type", "code": "institutional", "display": "Institutional" } ] }, "use": "claim", "patient": { "reference": "Patient/100000030006" }, "billablePeriod": { "start": "2022-06-14", "end": "2022-06-21" }, "created": "2022-06-21", "enterer": { "identifier": { "system": "https://fhir.kemkes.go.id/id/nik", "value": "3657746633553535555" }, "reference": "Practitioner/N10000001" }, "insurer": { "reference": "Organization/10080028" }, "provider": { "reference": "Organization/10085103" }, "priority": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/processpriority", "code": "normal", "display": "Normal" } ] }, "payee": { "type": { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/payeetype", "code": "provider", "display": "Provider" } ] }, "party": { "reference": "Organization/10085103" } }, "facility": { "reference": "Location/ec3e8a16-437b-4eba-b8f6-ce93c13ac480" }, "supportingInfo": [ { "sequence": 1, "category": { "coding": [ { "system": "http://terminology.kemkes.go.id/CodeSystem/claiminformationcategory", "code": "upgrade-class-indicator", "display": "Indikator Naik Kelas" } ] }, "code": { "coding": [ { "system": "http://terminology.kemkes.go.id/CodeSystem/upgradeClassIndicator", "code": "upgrade", "display": "Ada Kenaikan Kelas" } ] } }, { "sequence": 2, "category": { "coding": [ { "system": "http://terminology.kemkes.go.id/CodeSystem/claiminformationcategory", "code": "upgrade-class-class" } ] }, "code": { "coding": [ { "system": "http://terminology.kemkes.go.id/CodeSystem/locationServiceClass", "code": "2" } ] }, "timingPeriod": { "start": "2022-06-14", "end": "2022-06-21" } }, { "sequence": 3, "category": { "coding": [ { "system": "http://terminology.kemkes.go.id/CodeSystem/claiminformationcategory", "code": "claim-text-encoded" } ] }, "valueAttachment": { "contentType": "text/plain;base64", "data": "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" } }, { "sequence": 4, "category": { "coding": [ { "system": "http://terminology.kemkes.go.id/CodeSystem/claiminformationcategory", "code": "unu-grouper-version" } ] }, "valueString": "4" }, { "sequence": 5, "category": { "coding": [ { "system": "http://terminology.kemkes.go.id/CodeSystem/claiminformationcategory", "code": "e-klaim-version" } ] }, "valueString": "5.8.3.202301311257" } ], "diagnosis": [ { "sequence": 1, "diagnosisCodeableConcept": { "coding": [ { "system": "http://hl7.org/fhir/sid/icd-10", "code": "I21.9", "display": "Acute myocardial infarction, unspecified" } ] }, "type": [ { "coding": [ { "system": "http://terminology.hl7.org/CodeSystem/diagnosis-role", "code": "billing", "display": "Billing" } ] } ] } ], "procedure": [ { "sequence": 1, "procedureCodeableConcept": { "coding": [ { "system": "http://hl7.org/fhir/sid/icd-9-cm", "code": "36.06", "display": "Insertion of non-drug -eluting coronary artery stent(s)" } ] } }, { "sequence": 2, "procedureCodeableConcept": { "coding": [ { "system": "http://hl7.org/fhir/sid/icd-9-cm", "code": "00.66", "display": "Parcutaneous transluminal coronary angioplasty (PTCA) or coronary atherectomy" } ] } } ], "insurance": [ { "sequence": 1, "focal": true, "coverage": { "reference": "Coverage/acc4c2ac-5b2b-4002-a278-a1ce4559802d" }, "identifier": { "system": "http://sys-ids.kemkes.go.id/jkn-claim-number", "value": "100R01V0010002" } } ], "total": { "value": 28868200, "currency": "IDR" }, "extension": [ { "url": "https://fhir.kemkes.go.id/r4/StructureDefinition/Package", "extension": [ { "url": "tariffClass", "valueCodeableConcept": { "coding": [ { "system": "http://terminology.kemkes.go.id/CodeSystem/tariffClass", "code": "AP", "display": "Tarif Kelas A Pemerintah" } ] } }, { "url": "basePackage", "extension": [ { "url": "code", "valueCodeableConcept": { "coding": [ { "system": "http://terminology.kemkes.go.id/CodeSystem/inacbg-v5", "code": "I-1-40-I", "display": "PROSEDUR KARDIOVASKULAR PERKUTAN (RINGAN)" } ] } }, { "url": "value", "valueInteger": 14434100 } ] }, { "url": "additionalPackage", "extension": [ { "url": "code", "valueCodeableConcept": { "coding": [ { "system": "http://terminology.kemkes.go.id/CodeSystem/inacbg-special-cmg-v5", "code": "YY-02-III", "display": "PCI" } ] } }, { "url": "value", "valueInteger": 14434100 } ] } ] } ] }
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