[01]
Diagnosis & procedure coding
Diagnoses (ICD-10) and procedures (ICD-9-CM) are coded from the clinical documentation in the EMR as the basis for the claim submission.
[Integration] E-Klaim INA-CBG
E-Klaim INA-CBG.
ICD-10/ICD-9-CM coding into the INA-CBG grouper, with a fault-tolerant outbox queue — claims are resent automatically and never lost when the network drops.
The real problem
A claim left hanging is cash flow held back.
When the E-Klaim endpoint or the network runs into trouble, a claim can fail to send without a clear trace — the claims team has no idea which ones went through, and the hospital's revenue is held up. This is not a tariff problem; it is a delivery-reliability problem.
Adievia uses the outbox pattern: a claim is not sent "one try then gone" — it is queued and resent automatically until it succeeds, with a status that can be reconciled.
E-Klaim flow
From coding to a submitted claim.
[02]
INA-CBG grouper
The data is grouped through the INA-CBG grouper to determine the casemix tariff in line with the applicable rules.
[03]
Fault-tolerant outbox queue
Claims enter an outbox queue: if the network or endpoint drops, claims are resent automatically and are never lost.
[04]
Status reconciliation
Claim submission status is reconciled so the claims team knows which claims are sent, pending, or need follow-up.
Facing the iDRG transition
We prepare the technical foundation — we do not sell certainty that does not exist yet.
Indonesia's casemix is directed to move from INA-CBG to iDRG. There is no confirmed national go-live yet, and the transition may run dual-running. What we can be certain of now: clean ICD-10/ICD-9-CM coding and a grouper + outbox architecture designed to adapt to a new grouper format the moment the rules are final. We do not invent dates or status.
Complete guide to the INA-CBG to iDRG transitionFAQ
Questions about E-Klaim INA-CBG.
The outbox is a reliability-engineering pattern: a claim to be sent is first stored in a local queue, then delivered to the E-Klaim INA-CBG endpoint. If the connection fails, the claim is resent automatically and is never lost. This directly addresses a common operator complaint: claims that "hang" or fail when the endpoint is down.
Diagnoses use ICD-10 and procedures use ICD-9-CM, in line with INA-CBG casemix practice. Coding quality still depends on the completeness of the clinical documentation in the EMR.
We are honest: there is no confirmed national go-live for iDRG yet, and the transition scenario could involve dual-running. What we can prepare is the technical foundation — clean ICD-10/ICD-9-CM coding and a grouper + outbox architecture ready to adapt to a new grouper format once the rules are final. We do not invent dates.
Yes. Service data from the BPJS flow (member verification, SEP) feeds into INA-CBG claim preparation. See the BPJS VClaim integration page for the verification & SEP side.
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