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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