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All Journal Science Midwifery Journal of Management, Accounting, General Finance and International Economic Issues (MARGINAL)
Prabaswara, Raditya
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Decision Sciences, Operations Research & Management Dentistry Economics, Econometrics & Finance Environmental Science Health Professions Nursing Public Health Social Sciences Veterinary

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Minimization of Operational Costs for Non-Capitation Claims Verification at BPJS Kesehatan Using a Business Process Reengineering Approach Prabaswara, Raditya; Pratama, Novandra Rhezza
JOURNAL OF MANAGEMENT, ACCOUNTING, GENERAL FINANCE AND INTERNATIONAL ECONOMIC ISSUES Vol. 4 No. 3 (2025): JUNE
Publisher : Transpublika Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.55047/marginal.v4i3.1722

Abstract

Abstract This study aims to reduce operational costs in the FKTP claim verification business process by using a business process reengineering and TDABC approach and determine the resulting savings. In this study, the data collection method was carried out through participatory observation. The data analysis method in this study uses the Time-Driven Activity-Based Costing (TDABC) approach and business process simulation with iGrafx. The results of this study show that the implementation of Business Process Reengineering (BPR) in the verification process of non-capitation claims significantly improves cost efficiency and operational time. BPR was able to reduce operational costs by 33.1% and cut verification time by 32.9%, through process simplification, elimination of non-value-added activities, and the use of technology such as Optical Character Recognition (OCR). In addition to efficiency, BPR also improves overall organizational accountability and performance, enabling more appropriate resource allocation, reducing the potential for human error, and creating a more transparent, responsive, and sustainable work system. These findings show that BPR is not only a technical tool, but also an organizational transformation strategy that strengthens governance and service quality in the health insurance system.
Cluster analysis of province case mix index on Indonesian national health security (BPJS Kesehatan) system Prabaswara, Raditya; Kalla, Muhammad Ikhsan; Siregar, Penbi Opmel; Falihin, Muhammad Mizmara Alan; Simanjuntak, Benjamin Saut Parulian; Sormin, Samuel
Science Midwifery Vol 12 No 2 (2024): June: Health Sciences and related fields
Publisher : Institute of Computer Science (IOCS)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35335/midwifery.v12i2.1536

Abstract

Disease case is a diverse and complex problem which faced by health insurance institutions. BPJS Kesehatan, Indonesian national health security, has undoubtedly faced this problem, especially because of the socioeconomic gap between 34 provinces in Indonesia. To describe the diverse and complex conditions of resource needs for all hospital patients, this paper will calculate the Case Mix Index (CMI) for each province and conduct a cluster analysis to group provinces based on the CMI and total health facility visits similarity. Once the CMI for each province is identified, the cluster analysis is executed by using K-Means and Hierarchical clustering method to compare each result. The first step of cluster analysis is to identify the optimal number of clusters. In this article, several K-value selection techniques is used to find out the optimal number of clusters. By using K-value selection methods, the optimal number of clusters is two province clusters. The first cluster, namely Cluster 1, consists of four provinces which are DKI Jakarta, Jawa Barat, Jawa Tengah, and Jawa Timur. The second cluster, denoted as Cluster 2, consists of the rest provinces which are not included in Cluster 1. Although the optimal number of clusters are identified, this paper also adjust the cluster analysis result to provide comparison with the current INACBG regionalization. The result of this paper can be utilized as a recommendation for INA-CBGS tariff regionalization since using CMI as one of the clustering variables could depict the diverse condition in 34 provinces in Indonesia.
Co-Authors Falihin, Muhammad Mizmara Alan Kalla, Muhammad Ikhsan Novandra Rhezza Pratama Simanjuntak, Benjamin Saut Parulian Siregar, Penbi Opmel Sormin, Samuel