Business Intelligence-Based System to Enhance National Health Insurance Claim Reporting in Hospitals: Design and Optimization Approach

DOI

10.2991/978-94-6463-924-7_6How to use a DOI?

Keywords

Business Intellegence; Data Warehouse; Claim; JKN; Dashboard

Abstract

This study aims to design a system based on Business Intelligence (BI) with an integrated Data Warehouse (DW) foundation. The system was developed to address critical operational and financial challenges in the National Health Insurance (JKN) claim process as well as improve reporting efficiency in hospitals. Additionally, it is designed to transform the claim management pattern from an administrative function into a strategic function based on data. Our methodology employs a four-phase strategy: the first phase is the design of the system architecture, the next phase is the ETL (Extract, Transform, Load) process, the third phase is the development of a data warehouse, and the last phase is the development of business intelligence. As an outcome, this research presents a claims monitoring dashboard interface, which includes analysis of rejected claims, department performance, financial trends, and claims submission monitoring. This design primarily produces a set of interactive dashboards and analytical reports to facilitate strategic decision-making. This study obtained data from the Hospital Information System (SIMRS), integrated with the INACBG (Indonesia Case Based Groups) platform and the National Health Insurance (JKN) e-claim application. Data will be extracted in accordance with standards via the ETL process for presentation in BI format. In conclusion, the developed system can help optimize the JKN claims process, assist management in decision-making, and improve hospital claims acceptance. Thus, this research has an impact on improving the financial performance and income of hospitals.

Copyright

© 2025 The Author(s)

Open Access

Open Access This chapter is licensed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (http://creativecommons.org/licenses/by-nc/4.0/), which permits any noncommercial use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license and indicate if changes were made.

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TY  - CONF
AU  - Ade Jaja Nugraha
AU  - Hanhan Maulana
PY  - 2025
DA  - 2025/12/16
TI  - Business Intelligence-Based System to Enhance National Health Insurance Claim Reporting in Hospitals: Design and Optimization Approach
BT  - Proceedings of the 8th International Conference on Informatics, Engineering, Science & Technology (INCITEST 2025)
PB  - Atlantis Press
SP  - 54
EP  - 63
SN  - 2352-5401
UR  - https://doi.org/10.2991/978-94-6463-924-7_6
DO  - 10.2991/978-94-6463-924-7_6
ID  - Nugraha2025
ER  -