Claim Module Overview
The Claim module in Ksatria eHospital acts as an electronic repository for all health insurance data used in the hospital. It supports both:
Private insurance (from general health insurance companies)
Government insurance (such as BPJS or other government-funded health plans)
This module manages insurance provider and plan information used for patient claims and billing processes.
Provider Types
There are two main provider types that can be configured:
1. Insurance
Refers to general health insurance from a licensed health insurance company.
2. Company
Refers to corporate-sponsored medical coverage, typically given by employers.
*Note: This is not a medical insurance company, but a benefit provider.
Insurance Ownership Categories
Insurance providers are also classified based on ownership:
Government-Owned
Indicates that the insurer is owned or operated by a government agency or institution.Private
Indicates that the insurer is operated by a non-governmental or private organization.
Insurance Master Data Fields
The following information can be defined in the Insurance Master setup:
Insurance Name
Insurance Type (Insurance / Company)
Ownership Type (Government-Owned / Private)
Contact Person
Insurance Plan Name
Maximum Coverage Limit per plan
Supported Processes
Insurance Provider Management
Create Insurance Provider
Search Insurance Provider
Edit Insurance Provider
Insurance Plan Management
Create Insurance Plan
Search Insurance Plan
Edit Insurance Plan
Related Articles
Journal Module - Overview and How to Use
The Journal Module in Ksatria eHospital is used to generate accounting journals for transactions such as inventory movements and invoicing. These journals can then be exported and integrated with external financial applications. Journal Generation ...How to Register Patient
The Registration module is used by administrative staff to manage patient registrations and appointment scheduling. This module ensures that patient data is securely saved and distributed to the relevant departments. Note: Make sure the patient ...How to Manage Insurance Provider
This article covers how to create and search insurance providers in the Claim Module of Ksatria eHospital. Create Insurance Provider Purpose To register a new insurance provider into the system, including both private insurers and company-sponsored ...How to Manage Insurance Plan
This article explains how to create, search, and edit insurance plans in the Claim Module of Ksatria eHospital. Create Insurance Plan Purpose To register a new insurance plan under an existing insurance provider, including plan-specific coverage ...Changelog Ksatria eHospital v2508051 (05-08-2025)
New Features: Applied new changes on Patient Medical History and Pharmacy Process Applied new changes for Screen Behavior in the Operating Theatre module New field has been added in BPJS General Entity in preparation for Apotek Online features (in ...