Eligibility & Coverage
Cek BPJS V-Claim & asuransi swasta, plan & COB.
Pengelolaan benefit & klaim untuk BPJS dan asuransi swasta: eligibility, SEP/LOA, COB, tarif INA-CBGs, coding diagnosis/prosedur, grouping, submission e-claim, verifikasi, hingga rekonsiliasi pembayaran.
Cek BPJS V-Claim & asuransi swasta, plan & COB.
Pembuatan SEP, LOA, pre-auth & approvals.
Copay/deductible, plafon, Coordination of Benefits.
ICD-10, ICD-9/ICHI, INA-CBGs grouper.
Resume, hasil, foto, lampiran e-claim lengkap.
e-Claim/V-Claim API, status, retur & koreksi.
Validasi klinis & tarif; deteksi mismatch.
Pembayaran, selisih, retur klaim, aging & write-off.
Denial reasons, TAT, realisasi vs estimasi.
EMR/HIS, billing, ERP, insurance gateway/BPJS.
Eligibility & coding rules mengurangi penolakan.
Submission & rekonsiliasi efisien mempercepat cash-in.
Pelacakan status klaim end-to-end & audit trail.
Dukungan kebijakan dan standar regulator.
Integrasi EMR/billing mempercepat persiapan dokumen.