Materi Pelayanan Primer 032015

7/26/2019 Materi Pelayanan Primer 032015

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Ina OktikaKanit Manajemen PelayananKesehatan Primer

AyoSukseskan

BPJS Kesehatan CabangKlungkung

PELAYAAP!IME! BPJSKESE"A#A


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DEMI NKRIUNTUK INDONESIA YANG LEBIH SEHATUNTUK INDONESIA YANG LEBIH BAIK


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MODEL TRIPARTID

( S3 )PESERTA

SEHAT

FASKES

SEJAHTERA

BPJS Kesehatan

SUSTAIN

A$ministrasiPeserta

Premi

Klaim

Perjanjian Kerja Sama %

PembayaranKa&itasi'Klaim

PelayananKesehatan

Kartu


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J(MLA" )K#P BPJSKESE"A#A

CABA* KL(*K(* +,-.


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Peningkatan Mutu Pelaanan P!i"e!

Mutu Me#ik

Mutu Laanan N$nMe#ik

MutuD$ku"en

K(ALI#AS

%& In#ikat$! Kine!'a KTP

& Pelak*anaan P!$lani*3& O+ti"ali*a*i ,ung*i uta"a+elaanan +!i"e! $le- KTP

)K#P

(**(L%& Pu*ke*"a*& DPP3& Klinik.& a*ke* TNI/& a*ke* POLRI

JAMBO!E

)ASILI#ASKESE"A#A

)(*SI*A#E KEEPE!

I/IKA#O! PEILAIA K(ALI#ASM(#( PELAYAA P!IME! 01I 2 34

KontakPertama

(entita* uta"a+e"enu-anke0utu-anke*e-atan+e*e!ta)

%& Angka k$ntak k$"unika*i (Rate k$ntakk$"unika*i R1TP)

& Ra*i$ +e*e!ta 0e!kun'ung ke KTP lain(RPBL)

Kontinuitas(+e"eli-a!aanke*e-atan0e!kelan'utan)

%& Angka +e!+in#a-an +e*e!ta ke ,a*ke*lain (APPL)

& Rati$ kete!*e#iaan ,a"il ,$l#e! #ala"0entuk te!*e#iana #ata !i2aat+eng$0atan +e*e!ta #ala" P4a!e(Ra*i$ a"il $l#e!)

3& Ra*i$ 'u"la- +e*e!ta PROLANIS ang!utin 0e!kun'ung ke KTP (RPPB)

Koor$inasi(+elaanante!k$$!#ina*i#engan ,a*ke*te!kait)

%& Ra*i$ Ru'ukan Ka*u* N$n S+e*iali*tik(RRNS) #a!i KTP ke a*ke* TingkatLan'utan

& Tingkat keakti,an #ala" ,$!u"k$"unika*i anta! KTP (TKKTP)

Kom&rehensi5tas(+elaanan

"enelu!u-)

%& !e5uen*i E#uka*i KTP +a#a kegiatankel$"+$k RISTI +e! ta-un (!ekuen*iE#uka*i)

& Angka ke*akitan +e*e!ta te!#a,ta! #iKTP (AKPT)

3& Rek!e#en*ialing KTP

K(A#I#AS

PERLUASANKER1ASAMA KTPPena"0a-an KTP

PEMERATAAN DISTRIBUSIPESERTA TERDATAR

Ra*i$ #$kte!6+e*e!ta i#eal 7%6/&888


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. ung*i +$k$k +elaanan

+!i"e!

First Contact (Kontak pertama)Faskes Tk. I merupakan tempat pertama an! "#kun$un!# peserta set#ap

ka%# men"apat masa%ah kesehatan

Continuity (Kont#nu#tas pe%aanan)Hu&un!an Faskes Tk. I "en!an peserta "apat &er%an!sun! "en!an

kont#nu seh#n!!a penan!anan penak#t "apat &er$a%an opt#ma%

Coordination (Koor"#nas#) ' D$kkel *e0agai Care ManagerFaskes Tk. I &erperan se&a!a# koor"#nator pe%aanan &a!# peserta untuk

men"apatkan pe%aanan sesua# ke&utuhanna

Comprehensiveness (Komprehens#()Faskes Tk. I mem&er#kan pe%aanan an! komprehens#( terutama untuk

pe%aanan promot#( "an preent#(

Faskes Tk Pertama sebagaiGateKeeper *Star(#e%" B+ ,--)

Penguatan Sistem Gate Keeper


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oC!E/E#IALI

*

BOBO

#!EC!E/E#IALI*

BOB

O#- S/M 6.7 S/M +,7

+SA!AA %P!ASA!AA -.7

SA!AA %P!ASA!AA -.7

6

PE!ALA#AME/IS %OBA#8OBA#A -.7

PE!ALA#A ME/IS%OBA#8OBA#A -.7

9LI*K(PPELAYAA +,7 LI*K(P PELAYAA -.7

.KOMI#MEPELAYAA -.7

!EALISASIKOMI#MEPELAYAA -.7

: PEILAIA KIE!JA +,7

-,,7 -,,7


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E< !EALISASI KOMI#ME PELAYAA

-6


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oi*it&&

"ar$ Co&y 0la&oran !J#P tt$ &asien4

ke kant$! BP1S te!#ekat(KlungkungBangliGiana!Ka!anga*e")

Mak*i"al tanggal 3 0ulan 0e!ikutna
http://var/www/apps/conversion/tmp/scratch_5/data%20pcare%20sd%20des%2014.xlsxhttp://var/www/apps/conversion/tmp/scratch_5/data%20pcare%20sd%20des%2014.xlsxhttp://var/www/apps/conversion/tmp/scratch_5/data%20pcare%20sd%20des%2014.xlsxhttp://var/www/apps/conversion/tmp/scratch_5/data%20pcare%20sd%20des%2014.xlsxhttp://var/www/apps/conversion/tmp/scratch_5/data%20pcare%20sd%20des%2014.xlsx


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KEBI/AA>MA#E!AL8EOA#AL

0 BIDAN 7 1E1ARING KTP

(% Bi#an % KTP % KTP 0i*a J % 0i#an)

PKS 8%/ 6

0 Klai" "elalui KTP 6K$lekti, 0ulan (Mak* tgl %8 0ulan 0e!ikutna)

Pe!"enke* / 8%.

SE Di!an BP1S Ke*e-atan N$ %.3 8%.

(I"+le"enta*i Pe!"enke* /8%.)

Ke0i#anan +e!*alinan 6 N$n Ka+ita*i
http://var/www/apps/conversion/tmp/scratch_5/Permenkes%20No%2059%20thn%202014%20ttg%20Standar%20Tarif%20JKN.pdfhttp://var/www/apps/conversion/tmp/scratch_5/Permenkes%20No%2059%20thn%202014%20ttg%20Standar%20Tarif%20JKN.pdfhttp://var/www/apps/conversion/tmp/scratch_5/143.SE%20ttg%20implementasi%20permenkes%20nomor%2059%20tahun%202014%20ttg%20standar%20tarif%20pelayanan%20kesehatan%20dalam%20penyelenggaraan%20program%20JK.pdfhttp://var/www/apps/conversion/tmp/scratch_5/143.SE%20ttg%20implementasi%20permenkes%20nomor%2059%20tahun%202014%20ttg%20standar%20tarif%20pelayanan%20kesehatan%20dalam%20penyelenggaraan%20program%20JK.pdfhttp://var/www/apps/conversion/tmp/scratch_5/143.SE%20ttg%20implementasi%20permenkes%20nomor%2059%20tahun%202014%20ttg%20standar%20tarif%20pelayanan%20kesehatan%20dalam%20penyelenggaraan%20program%20JK.pdfhttp://var/www/apps/conversion/tmp/scratch_5/143.SE%20ttg%20implementasi%20permenkes%20nomor%2059%20tahun%202014%20ttg%20standar%20tarif%20pelayanan%20kesehatan%20dalam%20penyelenggaraan%20program%20JK.pdfhttp://var/www/apps/conversion/tmp/scratch_5/143.SE%20ttg%20implementasi%20permenkes%20nomor%2059%20tahun%202014%20ttg%20standar%20tarif%20pelayanan%20kesehatan%20dalam%20penyelenggaraan%20program%20JK.pdfhttp://var/www/apps/conversion/tmp/scratch_5/143.SE%20ttg%20implementasi%20permenkes%20nomor%2059%20tahun%202014%20ttg%20standar%20tarif%20pelayanan%20kesehatan%20dalam%20penyelenggaraan%20program%20JK.pdfhttp://var/www/apps/conversion/tmp/scratch_5/Permenkes%20No%2059%20thn%202014%20ttg%20Standar%20Tarif%20JKN.pdfhttp://var/www/apps/conversion/tmp/scratch_5/Permenkes%20No%2059%20thn%202014%20ttg%20Standar%20Tarif%20JKN.pdfhttp://var/www/apps/conversion/tmp/scratch_5/Permenkes%20No%2059%20thn%202014%20ttg%20Standar%20Tarif%20JKN.pdfhttp://var/www/apps/conversion/tmp/scratch_5/Permenkes%20No%2059%20thn%202014%20ttg%20Standar%20Tarif%20JKN.pdfhttp://var/www/apps/conversion/tmp/scratch_5/Permenkes%20No%2059%20thn%202014%20ttg%20Standar%20Tarif%20JKN.pdf


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!A?A# JALA #I*KA# PE!#AMA0!J#P4


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RAWAT INAP TINGKAT PERTAMA (RITP)

Dibayarkan berdasarkan Tarif Non Kapitasi


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Pemeriksaan#ari

Keterangan

Pelayanan Skrining

Kesehatan

- Pemeriksaan IDA R+& /&888

- Pemeriksaan

&a&smear

R+& %/&888

- Pemeriksaan */P

$an */PP

R+& 8&888 Pe! 1eni* Pe"e!ik*aan

(Ri*ik$ Tinggi DM)

- #era&i Krio R+& %/8&888

(*e!atu* li"a +ulu-

!i0u !u+ia-)

Untuk ka*u* I>A P$*iti,


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BE!KAS PE*AJ(A KLAIMKOLEK#I)


31/47

PE*AJ(A KLAIM !A?A# IAP


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BE!KASKLAIM
http://var/www/apps/conversion/tmp/scratch_5/List%20Berkas%20Klaim%20dan%20Form%20Informed%20Consent,%20bukti%20Pelayanan%20Non%20Kapitasi.xlsxhttp://var/www/apps/conversion/tmp/scratch_5/List%20Berkas%20Klaim%20dan%20Form%20Informed%20Consent,%20bukti%20Pelayanan%20Non%20Kapitasi.xlsxhttp://var/www/apps/conversion/tmp/scratch_5/List%20Berkas%20Klaim%20dan%20Form%20Informed%20Consent,%20bukti%20Pelayanan%20Non%20Kapitasi.xlsxhttp://var/www/apps/conversion/tmp/scratch_5/List%20Berkas%20Klaim%20dan%20Form%20Informed%20Consent,%20bukti%20Pelayanan%20Non%20Kapitasi.xlsx


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SKRINING PRE>ENTI PRIMER 6SKRINING RIAYAT KESEHATAN

0 Detek*i Dini DMHT 1antung K$!$ne! Gin'al K!$nik

0 Biaa Ent! R+/88

0 Selu!u- Pe*e!ta BP1S J 38 ta-un

0 Di#i*t!i0u*ikan ku"+ul ent! +a#a A+lika*i Lu+i*0 Ha*il Sk!ining () 6 DM !e*ik$ tinggi

Sk!ining Lan'utan DM t+e 6 GDP Q GDPP

Penga'uan Klai" 6 A+lika*i Lu+i* Reka+ PK K2itan*i

(Rangka+ 3) : Be!ka*


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SK!II* P!EDE#I) SEK(/E!

0 I>A (In*+ek*i >i*ual A*etat)

Pe*e!ta BP1S Ke*e-atan

anita J 38 t-n atau 0elu" 38 ta-un ta+i *u#a-"enika-

Mengi*i ke*e#iaan $!" +e!"$-$nan Detek*i DiniKanke!

Klai" 6 A+lika*i LUPIS : Be!ka* PK (lua!an Lu+i*)

$!" ke*e#iaan tt# Pe*e!ta

Ha*il +e"e!ik*aan

Reka+ Pelaanan

Kuitan*i

0 PAP SMEAR

0 KLAIM KOLEKTI BULAN

PALING LAMBAT TGL %8 BLN BERIKUTNYA (N%)


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HOME >ISIT

0 PKS (La"+i!an Ruang Lingku+)

0 Re!e#entialing

0 K$n*e+ Ke#$kte!an Kelua!ga

0 Mela+$!kan "ak* tgl / 0ulan 0e!ikutna

(#engan ei#ent

$!" H$"e >i*it ,$t$ #$ku"enta*i %l0!)

0 Ma*uk #ala" Pe"0iaaan Ka+ita*i


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P!OLAIS (PKS La"+i!an Ruang Lingku+ )- )K#P minimal memiliki - Klub Prolanis

%& Bentuk 4lu0 P!$lani* (38 Q /8 +e*e!ta DMHT)& Sena" P!$lani* 6

%9 *e"inggu

R+ /88&888 (In*t!uktu! *ena" K$n*u"*i)

Be!ka* Klai" 6

N$ta Kuitan*i 6 +e"0elian k$n*u"*i -$n$! in*t!uktu! *ena"

Da,ta! Ha#i! (tt# Pe*e!ta P!$lani*) La+$!an Kegiatan

D$ku"enta*i ( "in 3 $t$)

3& E#uka*i Kel$"+$k Ri*ti (E#uka*i Pe"e!ik*aan Ke*e-atan)

%9 *e0ulan

R+ 88&888 R+ %&88&888 (H$n$! +e"0ia!a BMHP

K$n*u"*i)

Be!ka* Klai" 6

N$ta #an Kuitan*i +e"0elian (0e!"ate!ai uku+) -$n$!

Da,ta! Ha#i! Ha*il Pe"e!ik*aan

La+$!an Kegiatan : Mate!i e#uka*i

D$ku"enta*i ( "in 3 $t$)


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PA1AK

BP1S Ke*e-atan *0agai a'i0 PungutPa'ak (APU)

NPP Pe!$!angan

.,7 #otal Ka&itasi Prosentase

Pajak /8 'uta 7 /

BE!SIE!*I MELAYAI

PESE!#A> ./


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PIC (I# MAAJEME

PELAYAA KESE"A#A P!IME! 0MPKP4

%& Ina Oktika 6 Kanit MPKP 8%%33%8.& Gu* i!a 6 A#"ini*t!a*i KTP (la+$!an A+lika*i I Kelu-an)

8%%3%%%C3& Gek Mi!a- 6 Klai" P!$g!a" Ru'uk Balik 8%3/3%33/.& 4$k De 6 P!$"$ti, P!eenti, (P!$lani* I>APa+ S"ea! Sk!ining)

8%%388


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ME/IA KOM(IKASI)K#P BPJS KESE"A#A CABA* KL(*K(*

E,ekti, Q e?*ien K$$!#ina*i k$"unika*i anta! KTP Q BP1S

Ke*e-atan

Pe!*a"aan +e!*e+*i !egula*i 1KN Q I"+le"enta*i

Peningkatan Pelaanan P!i"e!

(Ta-un 8%/ 6 Ta-un +eningkatan Kualita* Pelaanan P!i"e!)

%& EMAIL ina&$ktika0+'*ke*e-atan&g$&i#& BLA4KBERRY M Pin 6 =/%8.%3& -att*u++ 8%%33%8..& 4ATI

a& D$2nl$a# 6 An#!$i# Me**enge!222&at?V&$"#$2nl$a# in*tall

0& A## " NI4 6 =BAA83
http://www.catfiz.com/downloadhttp://www.catfiz.com/download

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Materi Pelayanan Primer 032015