The increasing number of participants in Indonesia’s Health Insurance Program has greatly increased the utilization of the services of and the number of claim reimbursements received by the Social Security Administering Body for the Health Sector (BPJS Kesehatan). This required a large number of additional resources and staff for claim administration processing. BPJS Kesehatan thus launched an initiative to simplify claims processing and management so that less resources would be needed. The initiative was named VEDIKA, short for Digital Claim Verification, a digital application for the claims verification process for secondary health facility reimbursement. The objectives of VEDIKA are to improve the financial performance of BPJS and its reputation, and to enable the organization to meet the service level agreement on claims processing time, thus optimizing the performance of the claims verification staff. After the implementation of VEDIKA, BPJS Kesehatan was able to reduce the length of claims processing from 45 days to 15 days. Another result of VEDIKA is that the total number of staff needed to support the verification process has fallen from 1,345 to 961. The key takeaways from the successful implementation of VEDIKA are provider support and a digital system.
In the context of the ISSA, a good practice is defined as any type of experience (e.g. an action, a measure, a process, a programme, a project, or a technology) implemented within a social security organization that fosters the improvement of its administrative and operational capacities, and/or the efficient and effective delivery of programmes. The good practices selected by the ISSA focus on topics related to the priorities as defined in the programme and budget of the Association. The good practices are from member institutions of the ISSA and are primarily collected through the work of the ISSA Technical Commissions and the ISSA Good Practice Awards.