[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.
The 30 July 2026 joint circular steers JKN claims onto SATUSEHAT-integrated EMR — pilots in August 2026, full enforcement targeted for 2027. Adievia's E-Klaim flow is built from EMR data in the first place (coding born from clinical documentation, not scanned files), so this policy direction aligns with the existing architecture. Technical rules await the circular's implementing guidance.
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