The Critical Improvement of Hospital Claim Fulfillment towards Public Insurance, using BPR and MIS Approach

Public insurance claim management in hospitals faces several problems managing claims hospital costs. This study aims to design improvement in the claim fulfillment process managed by the hospital using the Business Process Reengineering (BPR) and Management Information Systems (MIS) to improve service process time (efficiency) in submitting claim files and diminish claim file returns. Business process reengineering divided into two stages; modeling and simulating current business processes and proposed business processes. This study resulted in four scenarios to improve the public insurance claim process with different processing times in each scenario. The best scenario designed with entity-relationship diagram (ERD) and data flow diagram (DFD). The best combination of proposed scenarios uses Electronic Medical Record (EMR), Hospital Information Systems (HIS), and improved fulfillment claim systems at Public Insurance Institution. This study result average cycle business process time reduced from 28 days to 14 days with an increase in efficiency of 78,73%.