Lampiran Terminologi Pembiayaan Kesehatan Klaim Asuransi Swasta/Non BPJS
Coverage.class.value dan Coverage.class.name, serta CoverageEligibilityResponse.extension.policyClass.valueCodeableCondpet.coding untuk Benefit Kepesertaan
Coverage.class.system | Coverage.class.value | Coverage.class.name | Keterangan |
|---|---|---|---|
|
|
| |
COV000011 | Inpatient benefits | Rawat Inap | |
COV000004 | Ambulatory benefits | Rawat Jalan | |
270471004 | Maternity benefits | Maternity | |
COV000005 | Dental benefits | Dental | |
COV000006 | Optical benefits | Optikal | |
COV000007 | MCU benefits | Medical Check Up (MCU) | |
COV000008 | Immunization benefits | Imunisasi | |
COV000009 | Contraception benefits | Keluarga Berencana (KB) | |
COV000010 | Other benefits | Benefit Lainnya |
Coverage.type.coding untuk Tipe Coverage
Coverage.type.coding.system | Coverage.type.coding.code | Coverage.type.coding.display | Keterangan |
|---|---|---|---|
SOCIAL | social service program | Program sosial | |
WCBPOL | worker’s compensation | Kecelakaan kerja | |
PUBLICPOL | public healthcare | BPJS-K | |
WCBPOL | worker’s compensation | BPJS-TK | |
AUTOPOL | automobile | JASA RAHARJA | |
RETIRE | retiree health program | TASPEN | |
MILITARY | military health program | POLRI/ASABRI | |
LIFE | life insurance policy | Asuransi Jiwa | |
HIP | health insurance plan policy | Asuransi Umum |
QuestionnaireResponse.item.answer.valueCoding untuk Jenis Pelayanan
QuestionnaireResponse.item.answer.valueCoding.system | QuestionnaireResponse.item.answer.valueCoding.code | QuestionnaireResponse.item.answer.valueCoding.display | Keterangan |
|---|---|---|---|
IMP | inpatient encounter | Rawat Inap | |
AMB | ambulatory | Rawat Jalan | |
EMER | emergency | Instalasi Gawat Darurat | |
OBSENC | observation encounter | Observasi | |
SS | short stay | Kunjungan Pendek |
ChargeItem.performer.function.coding untuk Petugas yang Melakukan Tindakan/Layanan
ChargeItem.performer.function.coding.system | ChargeItem.performer.function.coding.code | ChargeItem.performer.function.coding.display |
|---|---|---|
88189002 | Anesthesiologist | |
309360001 | Rehabilitation physician | |
81464008 | Clinical pathologist | |
80933006 | Nuclear medicine physician | |
1255374004 | Clinical nutritionist | |
309338004 | Intensive care specialist | |
310191001 | Clinical psychologist | |
37504001 | Orthodontist | |
1259964002 | Oral medicine specialist | |
37154003 | Periodontist | |
68950000 | Prosthodontist | |
TK000023 | Prevensi dan Rehabilitasi Kardiovaskular | |
66862007 | Radiologist | |
17561000 | Cardiologist | |
1290289004 | Fellow physician | |
82296001 | Pediatrician | |
28411006 | Neonatologist | |
159016003 | Medical radiographer | |
11911009 | Nephrologist | |
62247001 | General practitioner | |
106289002 | Dentist | |
TK000024 | Emergensi dan Rawat Intensif Anak (ERIA) | |
82296001 | Pediatrician | |
39677007 | Internal medicine specialist | |
309367003 | Obstetrician and gynecologist | |
422234006 | Ophthalmologist | |
309372007 | Ear, nose and throat surgeon | |
56397003 | Neurologist | |
18803008 | Dermatologist | |
80584001 | Psychiatrist | |
41672002 | Respiratory disease specialist | |
TK000025 | Orthopedi dan Traumatologi | |
24590004 | Urologist | |
45544007 | Neurosurgeon | |
8724009 | Plastic surgeon | |
309383003 | Pediatric surgeon | |
309369000 | Cardiothoracic surgeon | |
309362009 | Forensic psychiatrist | |
49993003 | Oral surgeon | |
50149000 | Endodontist | |
90201008 | Pedodontist | |
304292004 | Surgeon |
ClaimResponse.adjudication.reason.coding untuk Status Klaim
ClaimResponse.adjudication.reason.coding.system | ClaimResponse.adjudication.reason.coding.code | ClaimResponse.adjudication.reason.coding.display |
|---|---|---|
http://terminology.kemkes.go.id/CodeSystem/claimresponse-adjudication | CRA000001 | Layak |
http://terminology.kemkes.go.id/CodeSystem/claimresponse-adjudication | CRA000002 | Tidak Layak |
http://terminology.kemkes.go.id/CodeSystem/claimresponse-adjudication | CRA000003 | Pending |
http://terminology.kemkes.go.id/CodeSystem/claimresponse-adjudication | CRA000004 | Kedaluwarsa |