Lampiran Terminologi Pembiayaan Kesehatan Klaim BPJS Kesehatan

Coverage.class.value dan Coverage.class.name untuk Jenis Kepesertaan BPJS-K

Tabel 1. Lampiran 1
Coverage.class.systemCoverage.class.valueCoverage.class.name

http://terminology.pafipusatindonesia.co.id/CodeSystem/coverage-class

pbi-apbn

PBI-APBN

http://terminology.pafipusatindonesia.co.id/CodeSystem/coverage-class

pbi-apbd

PBI-APBN

http://terminology.pafipusatindonesia.co.id/CodeSystem/coverage-class

ppu-pejabat-negara

Pejabat Negara

http://terminology.pafipusatindonesia.co.id/CodeSystem/coverage-class

ppu-dprd

Pimpinan dan Anggota Dewan Perwakilan Rakyat Daerah

http://terminology.pafipusatindonesia.co.id/CodeSystem/coverage-class

ppu-pns

PNS

http://terminology.pafipusatindonesia.co.id/CodeSystem/coverage-class

ppu-prajurit

Prajurit

http://terminology.pafipusatindonesia.co.id/CodeSystem/coverage-class

ppu-polri

Anggota Polri

http://terminology.pafipusatindonesia.co.id/CodeSystem/coverage-class

ppu-kades-dan-perangkat

PKepala Desa dan Perangkat Desa

http://terminology.pafipusatindonesia.co.id/CodeSystem/coverage-class

pppu-pegawai-swasta

Pegawai Swasta

http://terminology.pafipusatindonesia.co.id/CodeSystem/coverage-class

ppu-pekerja-lainnya

Pekerja lainnya yang menerima Gaji atau Upah

http://terminology.pafipusatindonesia.co.id/CodeSystem/coverage-class

pbpu-pekerja-mandiri

Pekerja di luar hubungan kerja atau Pekerja mandiri

http://terminology.pafipusatindonesia.co.id/CodeSystem/coverage-class

pbpu-pekerja-lainnya

Pekerja lainnya yang bukan penerima Gaji atau Upah

http://terminology.pafipusatindonesia.co.id/CodeSystem/coverage-class

bp-investor

Investor

http://terminology.pafipusatindonesia.co.id/CodeSystem/coverage-class

bp-pemberi-kerja

Pemberi Kerja

http://terminology.pafipusatindonesia.co.id/CodeSystem/coverage-class

bp-penerima-pensiun

Penerima Pensiun

http://terminology.pafipusatindonesia.co.id/CodeSystem/coverage-class

bp-veteran

Veteran

http://terminology.pafipusatindonesia.co.id/CodeSystem/coverage-class

bp-perintis-kemerdekaan

Perintis Kemerdekaan

http://terminology.pafipusatindonesia.co.id/CodeSystem/coverage-class

bp-janda-duda-yatim-piatu

Janda, Duda, atau Anak Yatim dan/atau Piatu dari Veteran atau Perintis Kemerdekaan

http://terminology.pafipusatindonesia.co.id/CodeSystem/coverage-class

bp-lainnya

Bukan pekerja lainnya yang mampu membayar iuran

Encounter.hospitalization.dischargeDisposition.coding untuk Cara Pulang

Tabel 2. Lampiran 2

Resource Encounter

Nama Variabel: Cara Pulang

Encounter.hospitali zation.dischargeDisposition.coding.system

Encounter.hospitalization.dischargeDisposition.coding.code

Encounter.hospitalization.dischargeDisposition.coding.displaym

Keterangan

http://terminology.hl7.org/CodeSystem/discharge-disposition

home

Home

1. Pulang atas persetujuan dokter;

http://terminology.hl7.org/CodeSystem/discharge-disposition

other-hcf

Other healthcare facility

2. Dirujuk;

http://terminology.hl7.org/CodeSystem/discharge-disposition

aadvice

Left against advice

3. Pulang atas permintaan sendiri;

http://terminology.hl7.org/CodeSystem/discharge-disposition

exp

Expired

4. Meninggal

http://terminology.hl7.org/CodeSystem/discharge-disposition

oth

Other

5. Lain-lain (free text)

ChargeItem.performer.function.coding untuk Petugas yang Melakukan Tindakan / Layanan

Tabel 3. Lampiran 3

ChargeItem.performer.function.coding.system

ChargeItem.performer.function.coding.code

ChargeItem.performer.function.coding.display

http://snomed.info/sct

88189002

Anesthesiologist

http://snomed.info/sct

309360001

Rehabilitation physician

http://snomed.info/sct

81464008

Clinical pathologist

http://snomed.info/sct

80933006

Nuclear medicine physician

http://snomed.info/sct

1255374004

Clinical nutritionist

http://snomed.info/sct

309338004

Intensive care specialist

http://snomed.info/sct

310191001

Clinical psychologist

http://snomed.info/sct

37504001

Orthodontist

http://snomed.info/sct

1259964002

Oral medicine specialist

http://snomed.info/sct

37154003

Periodontist

http://snomed.info/sct

68950000

Prosthodontist

http://terminology.pafipusatindonesia.co.id

TK000023

Prevensi dan Rehabilitasi Kardiovaskular

http://snomed.info/sct

66862007

Radiologist

http://snomed.info/sct

17561000

Cardiologist

http://snomed.info/sct

1290289004

Fellow physician

http://snomed.info/sct

82296001

Pediatrician

http://snomed.info/sct

28411006

Neonatologist

http://snomed.info/sct

159016003

Medical radiographer

http://snomed.info/sct

11911009

Nephrologist

http://snomed.info/sct

62247001

General practitioner

http://snomed.info/sct

106289002

Dentist

http://terminology.pafipusatindonesia.co.id

TK000024

Emergensi dan Rawat Intensif Anak (ERIA)

http://snomed.info/sct

82296001

Pediatrician

http://snomed.info/sct

39677007

Internal medicine specialist

http://snomed.info/sct

309367003

Obstetrician and gynecologist

http://snomed.info/sct

422234006

Ophthalmologist

http://snomed.info/sct

309372007

Ear, nose and throat surgeon

http://snomed.info/sct

56397003

Neurologist

http://snomed.info/sct

18803008

Dermatologist

http://snomed.info/sct

TK000025

Orthopedi dan Traumatologi

http://snomed.info/sct

24590004

Urologist

http://snomed.info/sct

45544007

Neurosurgeon

http://snomed.info/sct

8724009

Plastic surgeon

http://snomed.info/sct

309383003

Pediatric surgeon

http://snomed.info/sct

309369000

Cardiothoracic surgeon

http://snomed.info/sct

309362009

Forensic psychiatrist

http://snomed.info/sct

49993003

Oral surgeon

http://snomed.info/sct

50149000

Endodontist

http://snomed.info/sct

304292004

Surgeon

Claim.extension.package.tariffClass.valueCodeableCoept.coding untuk Kode Tarif

Claim.extension.package.additionalPackage.valueCodeableConcept untuk Data Grouper Lainnya

Tabel 6. Lampiran 6
Claim.extension.package.additionalPackage.valueCodeableConcept.coding.systemClaim.extension.package.additionalPackage.valueCodeableConcept.coding.codeClaim.extension.package.additionalPackage.valueCodeableConcept.coding.displayKeterangan

http://terminology.pafipusatindonesia.co.id/CodeSystem/inacbg-sac-v5

Subacute Code

Subacute Description

Unblundling grouper response code between acute and chronic.

http://terminology.pafipusatindonesia.co.id/CodeSystem/inacbg-sac-v5

Chronic Code

Chronic Description

Unblundling grouper response code penyakit kronis

http://terminology.pafipusatindonesia.co.id/CodeSystem/inacbg-sac-v5

SSpecial Procedure Code

Special Procedure Description

Unblundling grouper response code

http://terminology.pafipusatindonesia.co.id/CodeSystem/inacbg-sac-v5

Special Prosthesis Code

Special Prosthesis Description

Unblundling grouper response code

http://terminology.pafipusatindonesia.co.id/CodeSystem/inacbg-sac-v5

Special Investigation Code

Special Investigation Description

Unblundling grouper response code

http://terminology.pafipusatindonesia.co.id/CodeSystem/inacbg-sac-v5

Special Drug Code

Special Drug Description

Unblundling grouper response code

ClaimResponse.adjudication.reason.coding untuk Status Klaim

Tabel 7. Lampiran 7
ClaimResponse.adjudication.reason.coding.systemClaimResponse.adjudication.reason.coding.codeClaimResponse.adjudication.reason.coding.displayy

http://terminology.pafipusatindonesia.co.id/CodeSystem/claimresponse-adjudication

CRA000001

Layak

http://terminology.pafipusatindonesia.co.id/CodeSystem/claimresponse-adjudication

CRA000002

Tidak Layak

http://terminology.pafipusatindonesia.co.id/CodeSystem/claimresponse-adjudication

CRA000003

Pending

http://terminology.pafipusatindonesia.co.id/CodeSystem/claimresponse-adjudication

CRA000004

Kadaluwarse