TRANSLATOR’S STATEMENT

No. CBG/01/IOM/Apr/2020

We truly certify that the attached document is an accurate and true English
translation of the original Indonesian document attached thereto, to the
best of our abilities.

Kami menerangkan bahwa dengan sesungguh-sungguhnya bahwa dokumen

terlampir adalah terjemahan yang akurat dan tepat dalam Bahasa
Indonesia dari dokumen asli dalam Bahasa Inggris terlampir, yang dibuat
dengan sebaik-sebaiknya sesuai dengan kemampuan kami.

Jakarta, 13 April 2020

PT Citra Bahasa Global

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[SYMBOL]

DECREE OF THE MINISTER OF HEALTH OF THE

REPUBLIC OF INDONESIA

NUMBER HK.01.07/MENKES/238/2020
REGARDING
TECHNICAL GUIDELINE ON THE CLAIM FOR
REIMBURSEMENT FOR THE COST OF TREATMENT OF
SPECIFIC EMERGING INFECTIOUS DISEASE PATIENTS FOR
HOSPITALS PROVIDING CORONAVIRUS DISEASE 2019
(COVID-19) SERVICES

BY THE GRACE OF THE ALMIGHTY

GOD

THE MINISTER OF HEALTH OF THE

REPUBLIC OF INDONESIA,

Considering : a. whereas Coronavirus Disease 2019 (COVID-19)

has been designated as a specific emerging
infectious disease resulting in pandemic
(wabah) and resulting in a public health
emergency of international concern, not only
causing deaths but also causing relatively
significant economic losses, thus its
management needs to be conducted;
b. whereas to accelerate the process of
reimbursement for the cost of specific emerging
infectious disease in order to ensure
sustainable health services at Hospitals
providing Coronavirus Disease 2019 (COVID-
19) services, a technical guideline is needed;
c. whereas based on the consideration as referred
to in point a and point b, it is necessary to
stipulate a Decree of the Minister of Health
 -3-

regarding Technical Guideline on the Claim for

Financing Specific Emerging Infectious
Disease Patients for Hospitals providing
Coronavirus Disease 2019 (COVID-19)
Services;

In view of : 1. Law Number 4 Year 1984 regarding Infectious

Disease Epidemic/Wabah (State Gazette of the
Republic of Indonesia Year 1984 Number 20,
Supplement to the State Gazette of the
Republic of Indonesia Number 3237);
2. Law Number 24 Year 2007 regarding Disaster
Management (State Gazette of the Republic of
Indonesia Year 2007 Number 66, Supplement
to the State Gazette of the Republic of
Indonesia 4723);
3. Law Number 36 Year 2009 regarding Health
(State Gazette of the Republic of Indonesia Year
2009 Number 144, Supplement to the State
Gazette of the Republic of Indonesia 5063);
4. Law Number 44 Year 2009 regarding Hospitals
(State Gazette of the Republic of Indonesia Year
2009 Number 153, Supplement to the State
Gazette of the Republic of Indonesia Number
5072);
5. Law Number 23 Year 2014 regarding Local
Government (State Gazette of the Republic of
Indonesia Year 2014 Number 244,
Supplement to the State Gazette of the
Republic of Indonesia Number 5587) as
amended several times, most recently by Law
Number 9 Year 2015 regarding the Second
Amendment to Law Number 23 Year 2014
regarding Local Government (State Gazette of
the Republic of Indonesia Year 2015 Number
58, Supplement to the State Gazette of the
Republic of Indonesia Number 5679);
6. Law Number 6 Year 2018 regarding Health
 -4-

Quarantine (State Gazette of the Republic of

Indonesia Year 2018 Number 128,
Supplement to the State Gazette of the
Republic of Indonesia Number 6236);
7. Government Regulation Number 40 Year 1991
regarding Management of Infectious Disease
Epidemic/Wabah (State Gazette of the
Republic of Indonesia Year 1991 Number 49,
Supplement to the State Gazette Number
3447);
8. Regulation of the Minister of Health Number
1501/Menkes/Per/X/2010 regarding Specific
Infectious Disease Types Which May Result in
an Epidemic (Wabah) and Management
Measures thereof (Official Gazette of the
Republic of Indonesia Year 2010 Number
503);
9. Regulation of the Minister of Health Number 82
Year 2014 regarding Management of Infectious
Disease (Official Gazette of the Republic of
Indonesia Year 2014 Number 1755);
10. Regulation of the Minister of Health Number 64
Year 2015 regarding Organization and Work
Procedure of the Ministry of Health (Official
Gazette of the Republic of Indonesia Year 2015
Number 1508) as amended by Regulation of
the Minister of Health Number 30 Year 2018
regarding the Amendment to Regulation of the
Minister of Health Number 64 Year 2015
regarding Organization and Work Procedure of
the Ministry of Health (Official Gazette of the
Republic of Indonesia Year 2018 Number 945);
11. Regulation of the Minister of Health Number 52
Year 2016 regarding Health Service Rate
Standards in the Implementation of the Health
Insurance Program (Official Gazette of the
Republic of Indonesia Year 2016 Number 1601)
 -5-

as amended several times, most recently by

Regulation of the Minister of Health 6 Year
2018 regarding the Third Amendment to
Regulation of the Minister of Health Number 52
Year 2016 regarding Health Service Rate
Standards in the Implementation of the Health
Insurance Program (Official Gazette of the
Republic of Indonesia Year 2018 Number 442);
12. Regulation of the Minister of Health Number 59
Year 2016 regarding Cost Exemption for
Specific Emerging Disease Patients (Official
Gazette of the Republic of Indonesia Year 2016
Number 1968);
13. Decree of the Minister of Health Number
HK.01.07/Menkes/104/2020 regarding
Designation of Novel Coronavirus Infection
(2019-nCoV Infection) as a Disease Which May
Result in a Pandemic (Wabah) and Its
Management Measures;

HAS DECIDED:
To stipulate : DECREE OF THE MINISTER OF HEALTH
REGARDING TECHNICAL GUIDELINE ON THE
CLAIM FOR FINANCING SPECIFIC EMERGING
INFECTIOUS DISEASE PATIENTS FOR HOSPITALS
PROVIDING CORONAVIRUS DISEASE 2019
(COVID-19) SERVICES.

FIRST : To stipulate a Technical Guideline on the Claim for

Financing Specific Emerging Infectious Disease
Patients for Hospitals providing Coronavirus
Disease 2019 (COVID-19) Services hereinafter
referred to as Juknis (Technical Guidelines) on the
Claim for PIE (Penyakit Infeksi Emerging/Emerging
Infectious Disease) as set out in the Attachment
constituting an inseparable part of this Ministerial
Decree.
SECOND : Juknis on the Claim for PIE may be made as reference
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for the Central Government, Provincial

Governments, Regency/City Governments, Social
Security Administrator for Health, and hospitals
providing Coronavirus Disease 2019 (COVID-19)
services in applying for cost exemption for
Coronavirus Disease 2019 (COVID-19) patients.
THIRD : Hospitals providing Coronavirus Disease 2019
(COVID-19) services may make an application for
cost exemption for COVID-19 patients, for patients
treated since January 28, 2020.
FOURTH : The Ministry of Health, National Agency for Disaster
Management, Finance and Development
Supervisory Agency, Provincial Health Service
Offices, and Regency/City Health Service Offices
shall conduct mentoring and supervision of the
implementation of the Juknis on the Claim for PIE
in accordance with their respective authority.

FIFTH : This Ministerial Decree shall come into effect on

the date of its stipulation.

Stipulated in Jakarta on April 6, 2020

THE MINISTER OF HEALTH OF THE

REPUBLIC OF INDONESIA,

signed

TERAWAN AGUS PUTRANTO

Issued as a true copy

Head of the Legal Affairs and Organization Bureau

Secretariat General of the Ministry of Health,

[signed and stamped]

Sundoyo, SH, MKM, M.Hum

NIP 196504081988031002
 -7-

ATTACHMENT TO
DECREE OF THE MINISTER OF
HEALTH OF THE REPUBLIC OF
INDONESIA
NUMBER
HK.01.07/MENKES/238/2020
REGARDING
TECHNICAL GUIDELINE ON THE
CLAIM FOR FINANCING SPECIFIC
EMERGING INFECTIOUS DISEASE
PATIENTS FOR HOSPITALS
PROVIDING CORONAVIRUS DISEASE
2019 (COVID-19) SERVICES

CHAPTER I
INTRODUCTION

A. Background
On December 31, 2019, information on a Wuhan Pneumonia
disease caused by Coronavirus Disease 2019 (COVID-19) started to
spread. WHO has designated COVID-19 as Public Health
Emergency of International Concern (PHEIC)/Pandemic, with very
fast rapid infection on humans and relatively high mortality rate.
In Law Number 4 Year 1984 regarding Infectious Disease
Epidemic, it is stated that an epidemic/wabah is the outbreak of an
infectious disease in the community, where the number of victims
of which increases significantly, exceeding the number in a common
circumstance within a certain time and area as well as which may
cause a calamity. The Minister of Health designates certain disease
types which may cause an epidemic/wabah.
The Head of the National Agency for Disaster Management
has implement the Stipulation of Specific Circumstance Status of
Epidemic Disaster Emergency Due to Coronavirus in Indonesia
which is subsequently followed by Decision of the Head of the
National Agency for Disaster Management Number 13.A Year 2020
regarding Extension of Specific Circumstance Status of Epidemic
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Disaster Emergency Due to Coronavirus in Indonesia, effectively

extended for 91 (ninety-one) days, as from February 29, 2020 to
May 29, 2020.

Based on Regulation of the Minister of Health Number 59

Year 2016 regarding Cost Exemption for Specific Emerging
Infectious Disease Patients, financing for patients treated with
Specific Emerging Infectious Diseases including COVID-19 infection
may be claimed to the Ministry of Health through the Director
General of Health Services. This financing claim applies to patients
treated at hospitals providing Specific Emerging Infectious Disease
(PIE) services. At the moment, PIE referral hospitals and other
Hospitals providing specific infectious disease services have been
designated based a Decree of the Minister of Health. Considering
the tendency for high escalation of COVID-19 cases and need for
treatment at a hospital, the capacity of the designated referral
hospitals is unable to accommodate COVID-19 cases. Therefore, it
is necessary to encourage the involvement of all health service
facilities which are able to provide COVID-19 services thus health
services for COVID-19 patients can be provided optimally. In
addition, some COVID-19 cases are exacerbated by comorbidities
which cannot be managed by the designated referral hospitals.
To ease the implementation of payment for patients treated
with COVID-19, Juknis on the Claim for PIE needs to be prepared
for serving as a reference for hospitals providing COVID-19 services
in order to maintain service quality, service cost efficiency, and
health service sustainability for COVID-19 patients.

B. Objectives
1. General Objective
Organization of the claim for reimbursement for the cost of
treatment of specific emerging infectious disease patients for
hospitals providing COVID-19 services.
2. Specific Objectives
a. providing a reference for the Central Government, Provincial
Governments, Regency/City Governments, and hospitals
providing COVID-19 patient services;
b. providing a reference for verifying officers of the claim for
 -9-

health services for COVID-19 patients; and

c. providing the certainty of cost exemption for COVID-19 patients.

CHAPTER II
ORGANIZATION OF THE CLAIM FOR COVID-19
SERVICES

A. Criteria for patients whose cost of treatment may be claimed for

1. People under Observation (ODP)
a. ODP of the age of above 60 (sixty) years old with or without
any comorbidities.
b. ODP of the age of under 60 (sixty) years old with comorbidities.
2. People under Investigation (PDP)
3. COVID-19 Confirmation
Applicable to Indonesian Citizens and Foreign Citizens treated at a
hospital in the territory of the Unitary State of the Republic of
Indonesia.

B. Service Places
1. Outpatient
2. Inpatient
Referral hospitals managing specific emerging infectious
diseases and other hospitals providing COVID-19 patient
services.

C. Services which may be financed

1. Following the service standard in a patient administration guide
according to the patient's medical needs in accordance with
letter D below.
2. Service financing in outpatient and inpatient includes: service
administration, accommodation (rooms and services in
emergency rooms, inpatient rooms, intensive care units, and
isolation rooms), doctor service, treatments in rooms, use of
ventilator, medical consumables, diagnostic supporting
examination (laboratory and radiology according to medical
indications), medicines, medical equipment including use of
PPE in rooms, referral, handling the deceased, and other health
services according to medical indications.
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D. Service Standard
The therapy service standard in the following table serving as a
reference for services and supporting examination types is adjusted
for the capability of the health service facilities.

PDP PATIENTS
PDP PATIENTS WITH THE 2ND COVID-19 COVID-19
ODP PATIENTS WITH THE 2ND PCR PCR RESULT CONFIRMED CONFIRMED
RESULT OF OF NEGATIVE PATIENTS PATIENTS WITH
NEGATIVE WITH A A VENTILATOR
VENTILATOR

Outpatient Accommodation ICU Accommodation ICU

Doctor (Room) Accommodation (Room) Accommodation
Consultation Specialist Visit Specialist Visit Specialist Visit Specialist Visit

Room Room Room Room Room

Treatment Treatment Treatment Treatment Treatment

Subject to PE by Arterial/venous Arterial/venous Arterial/venous Arterial/venous

throat swab blood sampling blood sampling blood sampling blood sampling
culture Infusion setup Infusion setup Infusion setup Infusion setup
Medicine Medicine Medicine Medicine
injection 3x/day injection 3x/day injection 3x/day injection 3x/day
Throat swab Throat swab Throat swab Throat swab
culture culture culture culture
Intubation Intubation
Ventilator Ventilator
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PDP PATIENTS
PDP PATIENTS WITH THE 2ND COVID-19 COVID-19
ODP PATIENTS WITH THE 2ND PCR PCR RESULT CONFIRMED CONFIRMED
RESULT OF OF NEGATIVE PATIENTS PATIENTS WITH
NEGATIVE WITH A A VENTILATOR
VENTILATOR

Laboratory Support Laboratory Support Laboratory Laboratory Support Laboratory

Support Support
Routine blood Routine blood Routine blood
SGOT Real-Time Complete blood Real-Time Complete blood
SGPT Blood Sugar LED Blood Sugar LED
Blood Urea Routine blood Blood Urea Routine blood
Nitrogen Real-Time Nitrogen Real-Time
Creatinine Blood Sugar Creatinine Blood Sugar
SGOT Blood Urea SGOT SGPT Blood Urea
SGPT Nitrogen Sodium Nitrogen
Sodium Creatinine Potassium Creatinine
Potassium SGOT Chloride Blood SGOT
Chloride SGPT Gas Analysis SGPT
Blood Gas Sodium Sputum Culture Sodium
Analysis Potassium Microorganism Potassium
Sputum Culture Chloride Throat Swab during Chloride
Microorganism Blood Gas treatment Blood Gas
Throat Swab during Analysis Analysis
treatment Procalcitonin Procalcitonin
PT PT
APTT APTT
Bleeding time Bleeding time
Direct Bilirubin Direct Bilirubin
Indirect Bilirubin Indirect Bilirubin
Total Bilirubin Total Bilirubin
Lactic Acid Lactic Acid
CRP CRP
D Dimer D Dimer
Sputum Culture Sputum Culture
Throat Swab during Throat Swab during
treatment treatment

Thorax AP/PA Thorax AP/PA

All types of MO All types of MO
(aerob) culture with (aerob) culture
resistance with resistance
Anti HIV Anti HIV
Gas analysis Gas analysis
Radiology Radiology Radiology
Support Support Support

Thoracic Thoracic Radiograph Thoracic

Radiograph EKG Radiograph
EKG
Room PPE Room PPE Room PPE Room PPE

10 pairs of 10 pairs of 10 pairs of 10 pairs of

gynecology gynecology gynecology gynecology
gloves/day gloves/day gloves/day gloves/day
10 pairs of non- 10 pairs of non- 10 pairs of non- 10 pairs of non-
sterile short sterile short sterile short sterile short
gloves/day gloves/day gloves/day gloves/day
10 pcs of N95 3M 10 pcs of N95 3M 10 pcs of N95 3M 10 pcs of N95 3M
Masker/day Masker/day Masker/day Masker/day
10 pcs of Kimberly 10 pcs of Kimberly 10 pcs of Kimberly 10 pcs of Kimberly
sterile complete sterile complete sterile complete sterile complete
gown/day gown/day gown/day gown/day
10 pairs of shoe 10 pairs of shoe 10 pairs of shoe 10 pairs of shoe
cover/day cover/day cover/day cover/day
4 pcs of diaper/day 4 pcs of diaper/day 4 pcs of diaper/day 4 pcs of diaper/day
Medicines Medicines Medicines Medicines

Isotonic solution of Levofloxacin of 5 Isotonic solution of Levofloxacin of 5

500 cc mg/ml 500 cc mg/ml
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PDP PATIENTS
PDP PATIENTS WITH THE 2ND COVID-19 COVID-19
ODP PATIENTS WITH THE 2ND PCR PCR RESULT CONFIRMED CONFIRMED
RESULT OF OF NEGATIVE PATIENTS PATIENTS WITH
NEGATIVE WITH A A VENTILATOR
VENTILATOR

Terumo blood set Terumo blood set Oseltamivir 2x

Polysafety no 20 Oseltamivir 2x Polysafety no 20 75mg
Three way stop cock 75mg Three way stop cock Isotonic
N Acetylcysteine Isotonic N Acetylcysteine Solution
caps of 200 mg 3x a Solution caps of 200 mg 3x a N Acetylcysteine
day N Acetylcysteine day caps of 200 mg
Paracetamol tab of caps of 200 mg Paracetamol tab of Paracetamol tab of
500 mg 3x a day Paracetamol tab of 500 mg 3x a day 500 mg and inj
Hydrox of 450 ML 500 mg and inj Hydrox of 450 ML Hydrox of 450 ML
Hepatoprotector: Hydrox of 450 ML Hepatoprotector: Terumo blood set
Curcuma tablet 3x a Terumo blood set Curcuma tablet 3x a Cernevit Inj
day Cernevit Inj day Disp Spuit of 10 cc
Other medicines Disp Spuit of 10 cc Other medicines Tube and chamber
according to the Tube and chamber according to the Dexmedetomidine
patient's condition Dexmedetomidine patient's condition Lidocaine
Levofloxacin of 5 Lidocaine Levofloxacin of 5 Midazolam
mg/ml Midazolam mg/ml Morphine
Oseltamivir 2x Morphine Oseltamivir 2x Fentanyl
75mg Fentanyl 75mg Propofol
Vitamin C Hydrobag Vitamin C Rocuronium
Oral/Injection 3 x a Meropenem Oral/Injection 3 x a Hydrobag
day day Meropenem
Oxygen Therapy Oxygen Therapy
Other medicines
Other medicines Other medicines Other medicines
according to
according to the according to the according to
indications
patient's condition patient's condition indications
Additional Other Additional Other
examination and examinations and examination and examinations and
therapy according therapies therapy according therapies
to medical to medical
indication: According to indication: PT According to
PT comorbid comorbid
APTT
indications indications
APTT Bleeding time Direct
Bleeding time Bilirubin Indirect
Direct Bilirubin Bilirubin Total
Indirect Bilirubin Bilirubin Lactic Acid

Total Bilirubin Procalcitonin

Lactic Acid CRP

Procalcitonin D Dimer

CRP High Flow Oxygen

D Dimer Device

High Flow Oxygen Other examinations

Device and therapies

Other examinations According to comorbid

and therapies indications

According to comorbid
indications

E. Payment Method
The provided service and maximum treatment duration are
determined by using the INA-CBG rate and treatment Top Up is
taken into account as effective and efficient Cost per Day.

F. Norms of Rate
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1. Calculation of COVID-19 patient insurance rate:

a. Outpatient Claim Rate
Using the INA-CBG Rate
b. Inpatient Claim Rate
Patient Claim Rate = a+
((n.b)-a)-c Remarks:
Patient claim rate is the INA-CBG rate plus the
amount of patient LOS multiplied by cost per day
a = INA-CBG Rate n = amount of LOS
b = Top Up per Day (Cost per Day)
c = PPE and medicines from assistance
2. Amount of the INA-CBG Rate
a. The amount of INA-CBG rate for outpatient COVID 19
services uses the rate of regional 1 class A hospital.
b. The amount of INA-CBG rate for inpatient COVID-19 services
uses the rate of regional 1 class A hospital and Class 3
Treatment Class.
c. For hospitals making referral for COVID 19 to other
hospitals (referral hospitals and other hospitals providing
COVID19 services, amount a (INA-CBG Rate) is in accordance
with the norms of payment in number 8 (letter a up to letter d)
below.
3. Top UP per day (Cost per Day), including the following components:
a. Service Administration;
b. Accommodation in inpatient rooms;
c. Doctor service;
d. Outpatient and inpatient services, in emergency rooms,
common isolation rooms, ICU isolation rooms with a
ventilator, non-ventilator negative pressure isolation rooms;
e. Diagnostic supporting examination (laboratory and
radiology according to medical indications);
f. Medicines, medical equipment, and medical consumables;
g. Personal Protective Equipment (PPE);
h. Referral Ambulance;
i. Handling the deceased.

4. Top UP value per day (Cost per Day)

NO CRITERIA TOP UP/ DAY
ODP/PDP/CONFIRMATION WITHOUT ANY
 - 14 -

COMORBIDITIES/COMPLICATIONS
1 ICU with a ventilator 15,500,000
2 ICU without any ventilator 12,000,000
3 Negative pressure isolation with a ventilator 10,500,000
4 Negative pressure isolation without any 7,500,000
ventilator
5 Non-negative pressure isolation with a 10,500,000
ventilator
6 Non-negative pressure isolation without any 7,500,000
ventilator
ODP/PDP/CONFIRMATION WITH COMORBIDITIES/COMPLICATIONS
1 ICU with a ventilator 16,500,000
2 ICU without any ventilator 12,500,000
3 Negative pressure isolation with a ventilator 14,500,000
4 Negative pressure isolation without any 9,500,000
ventilator
5 Non-negative pressure isolation with a 14,500,000
ventilator
6 Non-negative pressure isolation without any 9,500,000
ventilator
5. For handling the deceased, the amount of cost is as follows:
NO CRITERIA AMOUNT
1. Handling the deceased 550,000
2. Body Bag 100,000
3. Coffin 1,750,000
4. Shrink Wrap 260,000
5. Corpse Disinfectant 100,000
6. Hearse transport 500,000
7. Hearse disinfectant 100,000

6. For hospitals receiving Personal Protective Equipment (PPE) and

medicine aids from the government, deductions from the
received claim will be made.

7. For Personal Protective Equipment (PPE) and medicines

purchased by hospitals, purchase invoices and other source
aids must be attached.
8. Hospitals referring COVID-19 patients to referral hospitals and
other hospitals providing COVID-19 patient services are subject
to the following norms of payment:
a. Treating for ≤ 6 hours, paid at the INA-CBG rate for outpatient.
b. Treating > 6 hours-2 days, paid at 70 % of the claim rate.
c. Treating > 2-5 days, paid at 80 % of the claim rate.
d. Treating > 5 days, paid at 100% of the claim rate.
9. With respect to COVID-19 patients which have been declared
recovered (discharged status) with the evidence of laboratory
 - 15 -

examination (according to the COVID-19 prevention and control

guide book), for comorbidities which still require treatment, the
subsequent treatment benefits are shifted to National Health
Insurance (JKN) service and/or general service.

G. Norms of Coding
1. The input process uses the application E-klaim INA-CBG v5 by
choosing the payment model “COVID-19 Insurance”
a. Participant Number is filled out with a Single Identity
Number (NIK) or other identity number.
b. Other variables are inputted by following the application E-klaim
INA-CBG v5.
2. Coding
In submitting a claim, a COVID-19 patient is claimed by
using the INA-CBG software. The provisions on coding used are
as follows:
a. For all patients with the supporting examination result of
positive Covid-19, use code B34.2 (Coronavirus Infection,
Unspecified Site) as the main diagnosis.
b. For ODP and PDP patients, use code Z03.8 (Observation for
other suspected diseases and conditions) as the main
diagnosis.
c. For newborns with the supporting examination result of
positive Covid-19, use code P39.8 (Other specified infections
specific to the perinatal period) as the main diagnosis.
d. For newborns with an ODP or PDP status, use code P96.8
(Other specified conditions originating in the perinatal
period) as the main diagnosis.
e. If there is a diagnosis other than COVID-19, for ODP and
PDP, it is coded as a secondary diagnosis.
NO DIAGNOSIS ODP PDP CONFIRM
INPATIENT AND OUTPATIENT
1 a. Main Z03.8 B34.2
diagnosis Observation for other Coronavirus
suspected diseases Infection,
Unspecified
b. Main P.96.8 P.39.8
Diagnosis Other specified conditions Other specified
for babies origination in the perinatal infections specific to
under 7 period perinatal period
 - 16 -

NO DIAGNOSIS ODP PDP CONFIRM

days
2 Secondary According to the patient's According to the
diagnosis comorbidity and patient's
complication condition comorbidity and
complication
condition
3 Procedure According to the According to the
procedure implemented on procedure
patients implemented on
patients

WHO has issued a COVID-19 coding guide, but the

submission of claim for COVID-19 patients refers to ICD-10 revision
2010 to code the main diagnosis and secondary diagnosis as well
as ICD-9-CM revision 2010 to code the treatment/procedure. Thus,
code U.07.1 (COVID-19) for COVID-19 patients is not used and is
equivalent to code B.34.2 (Coronavirus Infection, Unspecified Site).

H. Procedure for Claim Submission

1. Role and Function
a. Ministry of Health
1) The Minister of Health through the Director General of
Health Services will make the reimbursement for COVID-
19 patient treatment costs.
2) Making payments to hospitals providing COVID-19
services.
b. BPJS for Health
1) Conducting administrative management of claims by
organizing the governance of claim or billing data and
files from hospitals providing COVID-19 services
transparently and accountably.
2) Making the verification of health service billing from
hospitals providing COVID-19 services.
3) Making coordination with the Ministry of Health in the
context of process of claim billing payment to hospitals
which have been subject to a verification process.
4) The results of verification process in the form of Minutes
are delivered to the Ministry of Health.
c. Hospitals
 - 17 -

1) Making the recapitulation of data on the served COVID-19

patients.
2) Making submission of the claim for COVID-19 patient
treatment cost periodically.
3) Signing a claim payment Instruction.
4) Completing claim files in accordance with the provided
services, including: medical resume, type of treatment
room, service evidence (results of laboratory, radiograph
and others), identity card, encrypted TXT of the output
of application E-Klaim INACBG v5.
5) Receiving claim payments.
2. Procedure for Claim Submission
a. Hospitals submit a claim for the reimbursement for COVID-
19 patient treatment cost collectively to the Director General
of Health Services cq. Director of Referral Health Service with
a copy sent to BPJS for Health for verification and
Regency/City Health Service Office by email.
1) Email of the Ministry of Health:
pembayaranklaimcovid2020@gmail.com
2) Email of the local Regency/City Health Service Office.
3) Email of the Branch Office of BPJS for Health.
b. The COVID 19 patient treatment cost reimbursement claim
files which may be submitted by hospitals are for patients
treated since January 28, 2020.
c. The claim files submitted by hospitals in the soft copy form
of scanning results/claim file photograph (hard copy claim
files are retained at the hospitals) are for online upload.
d. Claims may be submitted by hospitals every 14 (fourteen)
working days.
e. BPJS for Health issues the Minutes of Service Billing Claim
Payment Verification by no later than 7 (seven) working days
as from the receipt of claims by BPJS for Health.
f. The Ministry of Health will pay hospitals within 3 (three)
working days after the receipt of Minutes of Claim
Verification Result from BPJS for Health.
g. Disputed cases will be subject to re-clarification and re-verification.
h. Contact person of the Ministry of Health: drg. Christiana
Hendarjudani (0818677387), Dra. Zuharina, Apt
 - 18 -

(082114252801).
i. Contact person of BPJS for Health: dr Indira Tania
(08116701883), Arif Asridin (08118408008).
3. Claim File Completeness
The claim files required in the COVID-19 claim verification
process are in the soft copy form of scanning result/file
photograph of namely:
a. Hospitals make an Absolute Responsibility Letter (SPTJM)
signed by the hospital management to state that they will be
responsible if in the future, a state loss is found due to a
claim amount mismatch in the examination/audit of the
Government Internal Supervisory Apparatus
(APIP)/BPK/BPKP/Inspectorate General in accordance with
form 1.
b. Hospitals make a patient claim payment application
proposal along with a patient recapitulation signed by the
hospital management in accordance with form 2.
c. Hospitals make a Service Billing Claim Payment Instruction
(SPK) signed by the hospital management together with a
Commitment-Making Official (PPK) in accordance with form 3.
d. The hospital management sign the Minutes of Service Billing
Claim Payment Verification together with BPJS for Health in
accordance with form 4.
e. The completeness of signature on files may be replaced by
an electronic signature.
 - 19 -

Form 1
HOSPITAL LETTER HEAD

ABSOLUTE RESPONSIBILITY STATEMENT

LETTER

The undersigned truly state that: 1. Name : ....................

NIP : ....................
Position : Management of .................... Hospital
Hospital Address : ....................
2. Truly state that the submitted patient treatment claim is true and
its financing has never been billed/paid by any parties.
3. If in the future, based on the examination/audit of Government
Internal Supervisory Apparatus (APIP)/BPK/BPKP/Inspectorate
General, it is stated that there is a state loss due to a COVID-19
patient service claim amount mismatch and claim over/excess
payment, we are willing to and absolutely responsible to re-
deposit such state loss to the state treasury.

We hereby truly draw up this absolute responsibility statement.

... (place), ....... (date)

Management of … Hospital

Stamp
Duty of
Rp 6000.-
....................
NIP ....................
 - 20 -

FORM 2
HOSPITAL LETTER HEAD

..., ... 20...

Number :
Attachments :
Re : Application for Patient Claim Payment

To: Director General of Health

Services of the Ministry of Health
Jl. H.R Rasuna Said Block
X-5 Kav 4-9 Jakarta

Based on Decree of the Minister of Health Number

HK.01.07/Menkes/.../2020 regarding Technical Guideline on the Claim for
Financing Specific Emerging Infectious Disease Patients for Hospitals
providing Coronavirus Disease 2019 (COVID-19) Services, we hereby inform
that .................... Hospital has handled COVID-19 patients totaling to
.................... patients with the total cost of Rp. ....................
(....................)
We attach the following:
a. Patient recapitulation; and
b. Patients' medical resume.
All of the claims have never been submitted to any programs
and have never been paid by the patients/ their family.
The claim payment may be made to the hospital's account
number
Account number : ....................
In the name of : ....................
Bank name, branch & address : ....................
Please be informed accordingly and thank you for your
attention.
Management of … Hospital

....................
NIP ....................
 - 21 -

HOSPITAL LETTER HEAD

PATIENT
RECAPITULATION

NIK/ Passport Medical Date of Date of Treatment Amount of Cost

Date of Birth
No. Patient Name No Record No Diagnosis Admission Discharge Therapy Duration (Rp)

...................., ... 20…

Management of … Hospital

....................
NIP ....................
 - 22 -

Form 3
HOSPITAL LETTER HEAD

COVID-19 PATIENT SERVICE

CLAIM INSTRUCTION BETWEEN THE COMMITMENT-MAKING
OFFICIAL AND .................... HOSPITAL
On this day, .................... the .................... of
............................................................................................................... ..
.
....................
We, the undersigned :
I. Name : ....................
Position : ....................
NIP. : ....................
Address : Jl. HR. Rasuna Said Block X5 Kav.
No. 4-9 South Jakarta
As the Commitment-Making Official hereinafter referred to as the
FIRST PARTY.

II. Name : ....................

Position : Management of .................... Hospital
NIP : ....................
Address : ....................
Hereinafter referred to as the SECOND PARTY.

Hereby state that both parties agree:

1. The FIRST PARTY to receive invoicing claims from the SECOND PARTY
and make patient treatment cost payments to the SECOND PARTY.
2. The SECOND PARTY to give the details of invoicing claims (attached).
3. The payment claim or invoicing claim is used for reimbursing the
treatment of COVID-19 patients treated at .................... Hospital
by the Account of .................... Bank Account Number ....................
4. The total COVID-19 treatment cost paid by the FIRST PARTY amounts
to the verification result set out in the Minutes of COVID-19 Patient
Treatment Billing Claim Payment Verification.
5. The COVID-19 patient treatment cost excludes the cost of Personal
Protective Equipment (PPE) and medicines originating from aids or
grants.
 - 23 -

6. The entire COVID-19 patient claim cost is charged to DIPA of the

National Agency for Disaster Management and or other sources in
accordance with the provisions of laws and regulations.

This Instruction (SPK) is drawn up for implementation in accordance with

the provisions of laws and regulations.

SECOND PARTY FIRST PARTY

Management of ... Hospital Commitment-Making
Official

.................... ....................
NIP .................... NIP ....................
 - 24 -

Form 4
HOSPITAL LETTER HEAD

MINUTES OF COVID-19
PATIENT SERVICE BILLING CLAIM PAYMENT
VERIFICATION AT ....................
NUMBER ....................

On this day, .................... of ....................

................................................................................................................ .
..
20..., in .................................... , we, the undersigned:

1. Name : ....................
NIP : ....................
Position : ....................
in this matter acting for and in the name of BPJS for Health
hereinafter referred to as the FIRST PARTY;

2. Name : ...............
NIP : ...............
Position : Management of ............... Hospital
in this matter acting for and on behalf of HOSPITAL
.............................................................................................................
hereinafter
referred to as the SECOND PARTY;

The FIRST PARTY states that after conducting verification of the

application for patient claim payment for the COVID-19 patient treatment
and medication in accordance with Letter Number ............... Dated
……………….. amounting to ............... (...............) patients with the total
claim of Rp ............... ( ........................................................................ )
(verification recapitulation attached).

The SECOND PARTY states that it has received the results of verification
of the application for patient claim payment for the COVID-19 patient
treatment and medication in accordance with Letter Number ...............
Dated amounting to ............... (...............) patients with the total claim of
 - 25 -

Rp ............... (...............).

These Minutes are hereby drawn up for due use.

SECOND PARTY FIRST PARTY

Management of ............... BPJS for Health

............... ...............
NIP ............... NIP ...............
 - 26 -

I. Procedure for claim verification by BPJS for Health

1. Administrative Verification
a. The verifying team conduct an administrative examination of
the completeness of claim files submitted by hospitals by
checking the conformity of claim files and the required files.
b. Matching the submitted invoice against the attached
supporting evidence.
c. In the event of mismatch between file completeness and
validity, the hospital completes the necessary file.
2. Patient Service Verification
a. The verifying team is obligated to ensure the completeness of
claim files.
b. The verifying team makes the calculation of service cost and
treatment duration in accordance with the services provided by
the hospital to patients.
c. Service and treatment duration are a series of Swab taking,
service administration, accommodation (rooms and services in
emergency rooms, inpatient room type, intensive care unit type,
and isolation room type), doctor service, treatments in rooms,
use of ventilator, medical consumables, diagnostic supporting
examination (laboratory and radiology according to medical
indications), medicines, medical equipment including use of
PPE in rooms, referral, corpse handling, and other health
services according to medical indications.
d. The results of verification by BPJS for Health in the form of the
Minutes of Claim Verification Results are submitted to the
Director General of Health Services cq. Director of Referral
Health Service, with a copy sent to the Inspectorate General of
the Ministry of Health for functional supervision on claim files.
e. If necessary, verification may be made at the hospital
submitting the claim.

J. Procedure for Claim Payment by the Ministry of Health

1. The cost of claim will be transferred to the account of the applying
hospital, after taking into account the provided advances.

2. The submitted claims have never been claimed in any programs (no
double claim) and are not borne by the patient or family concerned.
 - 27 -

In the event that the patient has paid the treatment cost, the
hospital must refund it.
3. Medical equipment including PPE, medicines, and medical
consumables which constitute aids may not be claimed.

K. Advances
The Ministry of Health may give the maximum advances of 50% (fifty
percent) of each amount of claim submitted by a hospital.

L. Claim Expiry Period

The claim expiry period is 3 (three) months after the designation of
Coronavirus Disease 2019 (COVID-19) as a type of disease resulting in
a public health emergency is revoked by the Central Government.

M. Mentoring and Supervision

The Ministry of Health, National Agency for Disaster Management,
Finance and Development Supervisory Agency, Provincial Health
Service Offices, and Regency/City Health Service Offices shall conduct
mentoring and supervision of the implementation of Juknis on the
Claim for PIE in accordance with their respective authority.

N. Financing Source:
The financing source is derived from DIPA of the National Agency for
Disaster Management and/or other sources in accordance with the
provisions of laws and regulations.

THE MINISTER OF HEALTH OF THE

REPUBLIC OF INDONESIA,

signed

TERAWAN AGUS PUTRANTO

Issued as a true copy

Head of the Legal Affairs and Organization Bureau

 - 28 -

Secretariat General of the Ministry of Health,

[signed and stamped]

Sundoyo, SH, MKM, M.Hum

NIP 196504081988031002