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The Claims module tracks BPJS non-capitation claims from submission to payment, as well as capitation receipts. BPJS Kesehatan is Indonesia's national health insurance agency (JKN program); clinics receive a fixed monthly capitation per enrolled member and claim certain services separately (non-capitation).
Non-capitation
- Claims → create a BPJS non-capitation claim for the covered period or services.
- Check the list of services and amounts; submit through the BPJS mechanism.
- Update the status: submitted → approved/partially paid → paid or rejected.
- Record the payment received in the bank account; differences or rejections are recorded with a reason.
Automatic journal entries: submitted Dr BPJS receivables · Cr BPJS non-capitation claim revenue; paid Dr BPJS receipts bank · Cr BPJS receivables; rejected/difference Dr Claim adjustments and rejections · Cr BPJS receivables.
Capitation
Record the capitation funds received each month: Dr BPJS receipts bank · Cr BPJS capitation revenue. A report on the use of capitation funds is available in the operational-financial reports.
Monitoring
- Claim status per payer and BPJS receivables aging (article Receivables aging).
- Ask the AI Assistant: "BPJS receivables older than 60 days".
Note: the accounting treatment of claims and capitation follows a template reviewed by accountants; clinics can adjust the posting rules together with their accountant.