Designing a Desktop-based Intelligent Information System on National Health Insurance (BPJS)

Firstanto Agung Pribadi, Farid Agushybana, Martha Irene Kartasurya

Keywords: Design, Information Systems, Smart Claims, Verification, FAST, Desktop-Based

Abstract

ABSTRACT

 

The hospital is a referral place for BPJS patients to get health services. The problem after the stipulation of digital claim verification (Vedika) by BPJS on January 1, 2018 is the submission of non-current BPJS claims caused by changes in BPJS claim regulations every year and verification of claims carried out conventionally. The purpose of this study is to develop a smart claim information system for internal verifiers in hospitals.

This research is an action research study with the FAST method system development approach. Development of smart claims information system with the FAST method, namely (1) a preliminary study, (2) problem analysis, (3) needs analysis, (4) logical design, (5) decision analysis, (6) physical design and integration, (7) construction and testing, (8) Distribution and Installation. The system implementation is implemented on a Windows-based operating system of at least version 7.0, the server uses OLEDDB connection. The programming language uses Visual Studio 2008 with MySQL version 2.0, while for the database using Access database files (ACCDB).

The results of this study are the formation of a claim verification information system for internal desktop-based hospital verifiers with verification codesfication verification features, operation verification codesfication, complete diagnostic support examination requirements with an output in the form of a claim verification report sheet that is ready to be used as a verification tool for completing claims for BPJS files. The use of the smart claims system in claim file verification takes 1-2 minutes for all cases. These results are compared with before the smart claims application takes 1-2 minutes for non-surgery cases and 5-6 minutes for surgery cases. The smart claims application can update the BPJS claim rules change into the smart claims database if there are BPJS claim rules that change every time

Published
2019-07-31