THE ENDORPIN APPLICATION: OPTIMIZE EFFICIENCY, MAXIMIZE SERVICE QUALITY

BPJS Kesehatan noted that the coverage of National Health Insurance (JKN) participants reached more than 269.49 million people or 95.7% of the total population in March 2024. Meanwhile, in Banyumas Regency, JKN users were 95.87% of the total population as of June 1, 2024. In the era of National Health Insurance (JKN) which uses the INACBG (Indonesian Case Base Group) system, namely a method of paying for patient care based on a diagnosis or case that is relatively the same. The Indonesian Tariff - Case Based Groups, hereinafter referred to as the INA-CBG's Tariff, is the amount of claim payment by BPJS Kesehatan to Advanced Health Facilities for service packages based on grouping disease diagnoses. The accuracy of the coding of diagnoses and actions not only affects the suitability of the tariff, but also affects the number of pending BPJS claims submitted by the hospital. Delayed claims will cause losses for the hospital due to delayed claim payments from BPJS.

Method

The ENDORPIN application helps hospitals in compiling diagnosis and procedure codes submitted to BPJS. The success indicators observed are monthly data: Hospital income, Severity level, Pending claim amount, Achievement of clinical pathways compliance value. Data collected for 12 months divided into 2 groups, namely 6 months before and after the implementation of ENDORPIN. The resulting differences were analyzed statistically using the independent T test.

Discussion

The ENDORPIN application is one of the innovations used in the hospital management system which is quite easy to access with the link https://endorpin.aicode.web.id/
The significance value of the independent T test of 0.009 (p <0.05) indicates that there is a significant difference every month after using the ENDORPIN application.
The impact of ENDORPIN innovation is as one of the cost and quality control efforts, including:
•Improving the accuracy of determining diagnosis codes and action codes according to ICD-10 and ICD-9.
•Minimizing the number of pending claims.
•Encouraging services according to clinical pathway standards and enforcing diagnoses according to clinical guidelines.