CASEMIX MANAGEMENT SYSTEM
Integrasi Data • Efisiensi Klaim • Optimalisasi Revenue
3
Admin CasemixCasemix Officer
Selesai
Pasien
Nina Hartono
00045915 · 28 tahun · P
Tanggal Masuk
10-09-2026 08:00
Tanggal Keluar
12-09-2026 08:00
LOS
2 hari
Ruang
Kenanga 2
DPJP Yang Merawat
dr. Rina Wulandari, Sp.OG
Penjamin
Umum
Jenis Pelayanan
Rawat Inap
Diagnosis
| Jenis | ICD-10 | Diagnosis | POA | Sumber |
|---|---|---|---|---|
| Utama | C50.9 | Ca mammae | Y | Khanza |
Prosedur ICD-9-CM
| Kode | Prosedur | Tanggal | Sumber |
|---|---|---|---|
| 39.95 | Hemodialysis | 10-09-2026 | CASEMIX |
| 88.76 | USG abdomen | 10-09-2026 | Khanza |
Monitoring Dokumen
| Dokumen | Status | Tanggal | Keterangan |
|---|---|---|---|
| Bukti Pelayanan | Lengkap | 10-09-2026 08:00 | - |
| CPPT | Lengkap | 10-09-2026 08:00 | - |
| Hasil Laboratorium | Lengkap | 10-09-2026 08:00 | - |
| Hasil Radiologi | Lengkap | 10-09-2026 08:00 | - |
| Informed Consent | Lengkap | 10-09-2026 08:00 | - |
| Lembar Operasi | Lengkap | 10-09-2026 08:00 | - |
| Resume Medis | Lengkap | 10-09-2026 08:00 | - |
| SEP | Lengkap | 10-09-2026 08:00 | - |
Coding Review
Coder 02Belum Review
Diagnosis utama: C50.9 · Severity: III
Tidak ada catatan.
-
Grouping INA-CBG
| Kode | Deskripsi | Severity | Tarif Dummy | Status |
|---|---|---|---|---|
| N-4-01-III | Grouping RSASM | III | Rp 0 | Grouped No Tariff |
| N-4-99-III | Grouping RSASM | III | Rp 0 | Grouped No Tariff |
| I-9-19-III | Ca mammae | III | Rp 12.531.387 | Draft |
Pembiayaan
Biaya Aktual
Rp 11.244.091
Estimasi Casemix
Rp 9.408.622
Estimasi Klaim
Rp 12.531.387
Margin
Rp 1.287.296
Klaim & Issue
| Nomor Klaim | Pengajuan | Disetujui | Status |
|---|---|---|---|
| CLM-2026-000238 | Rp 12.531.387 | Rp 0 | Dispute |
Issue Pending / Dispute
DisputeOpen
Perbedaan coding/diagnosis
PIC: Verifikator Klaim · Deadline: 2026-09-22