KAPJ: one patient, two payers — what hospitals should prepare

More and more patients hold both a JKN card and a private health insurance policy. The government and the financial services authority (OJK) are now pushing the two to pay in a coordinated way through coordination between insurance providers (KAPJ), also known as coordination of benefits.

What has happened so far

• The basis is an OJK rule. The Health Ministry and OJK point to OJK Regulation No. 36 of 2025, which governs health insurance products, as the basis for stronger coordination between commercial insurers and BPJS Kesehatan (Health Ministry, 3 September 2026).
• One payment, not two. According to the Ministry, there must be no duplicate payment, and ideally hospitals still receive payment from a single party.
• Agreements are being signed. As of 6 October 2026, 31 insurers had signed agreements with BPJS Kesehatan and 25 with hospitals. OJK hopes every insurer offering health insurance will have signed with both BPJS Kesehatan and hospitals by the end of 2026 (Health Ministry, 7 October 2026).
• The obstacles are acknowledged. OJK says implementation is still held back by data integration, differences in administrative and IT systems between institutions, benefit design, and claims mechanisms between payers (Kontan, 2 September 2026).

The year-end target is aimed at insurers, not a legal deadline for hospitals. But hospitals that work with private insurers will feel it at the registration desk and at the cashier.

What hospitals should prepare

1. Map the agreements in place. Which insurers already have KAPJ agreements with BPJS Kesehatan and with your hospital, and since when?
2. Record both payers at registration. JKN status and private policy details need to be captured when the patient arrives, not asked about at discharge.
3. Make sure the bill can be split. Billing needs to separate the part covered by JKN from the difference or extra benefits covered by the private insurer, within the same visit.
4. Use one source for supporting documents. The same medical resume and procedure details go to both payers. One documentation source reduces conflicting versions.
5. Wait for the technical details instead of guessing. We have not found the data-exchange format or the inter-payer claims flow published in detail. Do not build a custom flow on assumptions.

Our position

Adievia HMS has billing and BPJS claim-preparation modules. We do not yet claim bill splitting between payers for KAPJ. We are waiting for the data-exchange format and claims flow to be published before building it, and we will update this article once the details are out.

See also: JKN electronic claims guide.