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PELAKSANAAN PROGRAM JKN TAHUN 2016
Bandar Lampung, 6 APRIL 2016
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PENYELENGGARAAN JKN
JAMINAN KES NASIONAL
FASKESBPJSKESPEMERINTAH
PENYELENGGARA
JKN
PELAYANAN
KESEHATANREGULATOR
3
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UUD 1945
Pasal 34 ayat
(2) UU NO. 40 /2004
Ttg SJSN : Dasar
PengaturanPrgra! Ja!"nan
#ese$atan
UU N. 24/2011 Ttg
%PJS : Dasar
Peneta&an %PJS
#ese$atan se'aga"Pelasana Prgra!
Ja!"nan #ese$atan
P*P*S N. 12 /2013 tentang Ja!"nan
#ese$atan 'eserta Peru'a$annya
(P*P*S N. 111 /2013 +an N. 19/201,) :
Dasar &eras"nal Pelasanaan Ja!"nan
#ese$atan
PP N. 101 / 2012 +an PP
N. -,/2015 ttg Pener"!a
%antuan uran (P%)
Ja!"nan #ese$atan: Dasar
Peneta&an Peserta P%
a"r "s""n +an T"+a
a!&u(Ps. 1- UU SJSN : uran
Prgra! Ja!"nan Ss"al
'ag" a"r "s"n +an Orang
T"+a a!&u D"'ayar le$
Pe!er"nta$
Ps. 19 UU %PJS :
Pe!er"nta$ Pusat
e!'ayar +an enyetr
uran untu P% &a+a %PJS)
Dasar
Perintah
Konstitusi
Lahirnya
SJSN Melalui
UU
Peraturan
#e!enss:Peraturan
%PJS
Pasal 34“Nea!a"e#e"$a#
%a# s&s'e" (a"a#s)s&al $a&sel*!*+!a%,a' -a#"e"$e!-a,a%a#"as,a!a%a',a# le"a+-a# '&-a%"a".*ses*a&-e#a#"a!'a$a'%e"a#*s&aa#/
Regulasi
Peraturan
#e!enes
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.&!nl"ne.net
DESAIN JAMINAN KESEHATAN NASIONAL
PROVIDER PESERTA/PASIEN
BPJS KES
Pelayanan KesehatanKOMPREHENSIF
Prospektif Pembayaran
iuran
Paket Benet
PENYELENGGARAAN NIRLABA, DANA AMANAH PORTABILITAS , PROFESIONAL,PELAYANAN
TERSTRUKTUR , BERKEADILAN, SOLIDARITAS SOSIAL,
MENDORONG : PENERAPAN SPM, STANDAR/MUTU, TARIF, WIN-WIN
SOLUTION, RS TIDAK DIRUGIKAN, YANKES LEBIH FAIR, KOMPETISI/PERSAINGAN USAHA
JKN
TERKENALI
KONTRAK /MO TELAA! TILISASI
KONTROL,PEN"A#ASANSTANDAR, DSB
Regula!"
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Ma#aa' (a"a# %ese+a'a# $e!s&a' .ela,a#a#
.e!se)!a#a# ,a# "e#a%*. .ela,a#a# .!)")'&
.!e5e#'& %*!a'& -a# !e+a$&l&'a'& 'e!"as*% )$a'-a# $a+a# "e-&s +a$&s .a%a& ,a# -&.e!l*%a#
PAKET MANFAAT JKN
Pela,a#a# ,a# -&$a'as& "el&.*'&$%a&a ma'a, a(a' )an'u d*ngar +*ar-nga-d., a(a' )an'u g*ra% +'ng%a'p*nangga, %ur- rda dan %r*'.,
Pela,a#a# , '&-a% -&(a"$a. T-da% *ua- pr*dur
). P*(aanan d-(uar a%* 3g )*%*r4aama dng BPJS&. P*(aanan )*r'u4uan %m*'-%,d. "*n*ra( &*&% up, p*ng)a'an a('*rna'-5,*. P*ng)a'an un'u% m*ndapa'%an %*'urunan,
P*ng)a'an Imp'*n-,5. P*(aanan K* Pada Saa' B*n&ana Dang. Pa-*n Bunu D-r- /P*na%-' 3g T-m)u( A%-)a'
K**nga4aan n'u% M*n-%a D-r- S*nd-r-/ BunuD-r-/Nar%)a
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6
ARAH PENGEMB PEMBIAAAN ! JK KEDEPAN
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PENGEMB PEMBIAAAN ! JAMINAN KES
"
Arah penyesuaian peran, bergerak dengan prioritas pada pengemb pembiayaan
kesehatan serta pemantapan pengemb dan pelaksanaan jaminan kesehatan
JAMKESMAS #$$$$$%
BIAKES #$$%
SASARAN&'ERSELENGGARA
NA PENGUA'AN
JKN
ERA SEBELUM JKN
ERA JKN
BIAKES #$$$$$%
JAMKES #$$%
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PENGEMB BIAKES ! JAMKES
(
PEMBIAAAN
KESEHA'AN
J#NPR)GRAMKESMAS
PEMBIAAAN
KESEHA'AN
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KEMENKES
*
PEMBIAAAN KES UKP JKN
UUD +*,- #Ps .(/ 0,%/UU No1 ,23.22,/
UU No1 .,3.2++
PP +2+3.2+./ PP
"63.2+-PERPRES +. /
+++ 'H .2+0 4an
+*3.2+6 serta 0.3.2+,1
PERMENKES 6*3.2+0
! -*3.2+,/ "+3.2+0 !
**3.2+- +*3.2+,/."3.2+,
4an .(3.2+,1
Ja5inan
Perlin4ungan
Kesehatan
agi seluruh
7en4u4u83
5asyara8at
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SUMBER PEMBIAAAN JKN
+2
IURAN N)N PBI#PEKERJA DAN
PEMBERI KERJA%
IURAN PBI APBNIURAN PBI APBD
BIAA
ANKES
BIAA
)PERASI)NAL
BIAA 9ADANGAN
BPJS KESEHA'AN
BIAA PELAANAN KES
PENDANAAN JKN
JASPEL
DUKUNGAN
)PERASI)NAL ANKES
P))LING IURAN
BAAR
:ASKES
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JKN
DI KRTL
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ALUR PENGEL)LAAN DANA JKN
DI :KR'L
+0
BPJS KES
RS SDH BLUD
PENGAJUAN KLAIM
#INA 9BG?s%
RS BLM
BLUD
PENGAJUAN KLAIM
#INA 9BG?s%
BAAR KLAIM
L A P
) R
KAS DAERAH
#KASDA%
S
E ' ) R
AN
KES
AN
KES
RKA@DPA RSSESUAI
RBA@DPA
BLUD
PEMAN:AA'AN DANA JKN DI :KR'L
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KEMENKES
+,
PEMAN:AA'AN DANA JKN DI :KR'L
PERMENKES .(3.2+,
RKA@DPA3RBA@DPA
RS
Menyusun ! Mengusul8an 8eg
1. JASPEL 02@-2
2. DUKUNGAN )PPELA #)at/ BHP/
Al8es/ A45/ 4ll%
D)KUMAN ANGGARAN PEMAN:AA'AN
PED)MAN PELAKSANAAN JKN
DIPA
SA'
KER
Untu !e!anaatan e!'al" #la"! yang tela$ +"ter"!a #*T6 !enyusun +an
!engusulan +ala! 'entu eg"atan &a+a +u!en anggaran sesua" +engan
e'utu$an !as"ng!as"ng. Se'aga"!ana +"atur +ala! P*N#S 27/2014 #*T6
+a&at !engalas"an J8SP6 seesar 02@-2 +ar" #la"! yang +"ter"!a +an s"sanya
untu Duungan O&eras"nal Pelayanan #ese$atan
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Per!asala$an Pelasanaan J#N :
1. Pergu' N. 27 Ta$un 2015 Tentang Peru'a$an
8tas Pergu' N. 43 Ta$un 2013 Tentang
Pe+!an Pelasanaan S"ste! *uuan
Pelayanan #ese$atan2. #!&etens" SD
3. S"ste! "nr!as" ruuan 'erenang
4. Pen+"a!an %PJS ter$a+a& +ter5. #re+ens"all"ng ases Ole$ %PJS
,. De"n"s" st S$er"ng 6anut Pena'aran
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Pergu' N. 27 Ta$un 2015 Tentang Peru'a$an
8tas Pergu' N. 43 Ta$un 2013 Tentang
Pe+!an Pelasanaan S"ste! *uuanPelayanan #ese$atan
Pergu' "n" +"a+"an +asar 'ag" %PJS untu
t"+a !e!'ayaran la"! +engan alasan sala$
&rse+ur '"la &as"en +"layan" +" ases yangt"+a sesua" +engan reg"nal &as"en.
Pergu' "n" 'ertentangan +engan $a &as"en
untu !e!"l"$ &elayanan ese$atan +an+"!anaa$ leta &rta'"l"tas J#N;
8+a e $aat"ran *S untu !elayan" &as"en
+"luar reg"nal se!est"nya se$"ngga &leyanan
yang +"'er"an t"+a &t"!al.
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3. S"ste! "nr!as" ruuan
'erenang S"ste! "nr!as" ruuan 'erenang
'elu! +"alanan se$"ngga $al "n" uga
!erug"an &as"en.
Se'elu! !eruu ases yang !eruu
su+a$ +a&at !e!ast"an 'a$a &as"en
+a&at +"tangan" +" ases tuuan.
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4. Pe!'"aran %PJS ter$a+a& Pelayanan +ter
S&es"al"s +engan
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5. #re+ens"all"ng ases Ole$ %PJS
Dala! Per&res N. 19 Ta$un 201, Pasal 3, 8yat
4 (a) +"se'utan =Dala! ranga &elasanaan era
sarana +engan as"l"tas #ese$atan %PJS
#ese$atan 'err+"nas" +engan +"nas ese$atana'u&aten/ta>. ?al "n" !enegasan &elasanaan
&asal 35 &er&res 12 ta$un 2013 'a$a &a+a
+asarnya eterse+"aan ases +an naes a+ala$
tanggung aa' &e!er"nta$ +an &e!+a. 8an teta&" enyataan yang a+a +"la&angan
&eraturan "n" 'elu! +"alanan le$ %PJS.
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Penga+uan asyaraat
all Prate yang +"lauan le$ sala$
satu l"n" #l"n" elauan O&eras"
Se
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,. De"n"s" st S$ar"ng
nt$ #asus :
Pas"en #elas 2 +"raat +"elas !anaa$
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Slus"
e!'uat regulas" Pergu' yang le'"$ ter&er"n
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ungs" Pert"!'angan #l"n"s
(l"n"
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De"n"s"
e7a# Pe!'&"$a#a# Kl&s ada(a d*=an ang d-)*n'u%(* M*n'*r-K**a'an ang '*rd-r- dar- unur %*m*n'*r-an %**a'an,rgan-a- pr5*- dan a%ad*m-- %*d%'*ran un'u%
m*m)*r-%an p*r'-m)angan %(-n- da(am p*(a%anaan Jam-nan K**a'an Na-na(<
T&" Pe!'&"$a#a# Kl&s ada(a '-m ang d-)*n'u% (*"u)*rnur '*rd-r- dar- unur D-na K**a'an Pr8-n-,
rgan-a- pr5*- dan a%ad*m-- %*d%'*ran *)aga-p*r=a%-(an D*=an P*r'-m)angan K(-n- da(am m*m)an'um*n*(*a-%an p*rma(aan %(-n- ang m*n4ad- *ng%*'a d-'-ng%a' pr8-n-<
Pe#a-* ada(a p**r'a Jam-nan K**a'an Na-na(,
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De"n"s" (2)
Pe!"asala+a# Kl&s ada(a maa(a angm*nang%u' dan/a'au )*rdampa% '*radappa%*' man5aa' dan/a'au p*m)aaran %(a-m
ang '*r4ad- da(am p*(aanan %**a'an padap*n*(*nggaraan JKN<
Se#%e'a ada(a %*'-da%*paaman ang '*r%a-'
p*rmaa(aan %(-n- an'ar p-a% p*ngadu pada aa'a'au *uda p*(aanan %**a'an da(amp*n*(*nggaraan JKN ang )*r=u4ud d-adu%anna a'up-a% (* p-a% (a-nna %*pada P*m*r-n'a Pua'a'au P*m*r-n'a Da*ra Pr8-n- ang m*m)-dang-uruan %**a'an ang )*r-5a' pra? m*d-a- dan '-da%m*rupa%an p*r%ara p*rda'a dan/a'au p-dana
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6e!'aga engurus asala$ Tera"t J#N
T"! #en+al"
utu
#en+al" %"aya
Dean
Pert"!'angan
e+"
%a+an
Pengaas
*u!a$ Sa"t
8nt" rau+
Dean
Pert"!'angan
#l"n"s
##
a'ang
##
"laya
##
Pusat
%PJS #a'/#ta
Au'ernur
#D# enes
T"!
T"!
Pen
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#eanggtaan
a< D*=an P*r'-m)angan K(-n-
Jum(a @ 1> rang
'*rd-r- dar- @
unur %*m*n'*r-an %**a'an *)aga-ex ofcio
unur rgan-a- pr5*- a%ad*m-- %*d%'*ran
K*'ua dar- (uar unur K*m*n'*r-anK**a'an
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1< Maa Ja)a'anD*=an
> 'aun *4a% d-'*'ap%anna
K*pu'uan M*n'*r- K**a'an '*n'angD*=an P*r'-m)angan K(-n-
D-'-n4au u(ang *'-ap a%-r maa 4a)a'an<
> dar- 1> rang angg'a D*=an
P*r'-m)angan K(-n- dapa' d-p*rpan4angmaa 4a)a'anna *(ama 1 'aun *'*(amaa 4a)a'an )*ra%-r
Ja)a'an Angg'a D*=an )*ra%-rapa)-(a @
Maa 4a)a'anna )*ra%-r$
M*ngundur%an d-r-$
M*n-ngga( dun-a$ a'au
D-)*r*n'-%an )*rdaar%an %*pu'uanM*n'*r-
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2< Rang%ap Ja)a'an
Angg'a D*=an '-da% )(* m*rang%ap 4a)a'an (a-n ang dapa' m*n-m)u(%an)*n'uran %*p*n'-ngan dan/a'aum*ngganggu %-n*r4a D*=an P*r'-m)anganK(-n-<
>
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S,a!a'Kea#)'aa#
8al)# e7a# Pe!'&"$a#a# Kl&s +a!*s
"e"e#*+& .e!s,a!a'a##arga n*gara Indn*-a$
S*a' 9-% dan m*n'a($
:a%ap, 4u4ur, m*m-(-%- mra(, *'-%a, -n'*gr-'a ang'-ngg-, m*m-(-%- r*pu'a- ang )a-%, dan m*maam-maa(a ang )*r%a-'an d*ngan p*n*(*nggaraan $B*ru-a pa(-ng r*nda 0 +*mpa' pu(u. 'aun$
T-da% m*n4ad- angg'a a(a a'u par'a- p(-'-%$
B*raa( dar- pr5*- %*d%'*ran$
T-da% p*rna d-p-dana p*n4ara )*rdaar%an pu'uanp*ngad-(an ang '*(a m*mp*r(* %*%ua'an u%um'*'ap %ar*na m*(a%u%an '-nda% p-dana ang d-an&amd*ngan p-dana p*n4ara +(-ma. 'aun a'au (*)-<
' T" P " ' #l" "
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'. T"! Pert"!'angan #l"n"s
T-m P*r'-m)angan K(-n- )*r%*dudu%an d-
Pr8-n-, B*rangg'a%an gan4-( an'ara >? rang ang
'*rd-r- dar- @ unur rgan-a- pr5*-
a%ad*m-- %*d%'*ran<
T-mP*r'-m)angan K(-n- d-'*'ap%and*ngan K*pu'uan "u)*rnur
T-m P*r'-m)angan K(-n- d-)*n'u% pa(-ng (am)a' Januar- 201C
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Trans"s" T"!
S*)*(um T-m P*r'-m)angan K(-n- ang)*r-5a' '*'ap d-)*n'u%, 'ugap*n*(*a-an p*rmaa(aan K(-n- '-ng%a'pr8-n- d-(a%u%an (* T&" M)#e5-a# Pe!'&"$a#a# Kl&s JKN7 '-ng%a'
Pr8-n- $&-a# Pe!'&"$a#a# Kl&s< K*angg'aan p*r'-m)angan %(-n- da(am
T-m Mn*8 dan P*r'-m)angan K(-n- JKN7'-ng%a' Pr8-n- '*rd-r- dar- Ka)-d 3an%*D-na K**a'an *)aga- %*'ua, 1 +a'u.'*naga d%'*r d- d-na %**a'an pr8-n-,1 +a'u. '*naga d%'*r dar- MKEK IDI=-(aa<
Da(am M*(a%u%an 'u an a T-m Mn*8
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Da(am m*(a%ana%an 'ugana, D*=anP*r'-m)angan K(-n- d-)an'u (**%r*'ar-a' ang )*r%*dudu%an d-Pua' P*m)-aaan dan Jam-nan
K**a'an< S*%r*'ar-a' *)aga-mana d-ma%ud
d-p-mp-n (* *%r*'ar- ang *&araeks ofcio d-4a)a' (* p*4a)a'
'ru%'ura( ang m*m)-dang- Jam-nanK**a'an<
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Da(am m*(a%ana%an 'ugana, T-mP*r'-m)angan K(-n- Pr8-n- d-)an'u(* *%r*'ar-a' ang )*r%*dudu%an d-
D-na K**a'an Pr8-n- ang m*m-(-%-'uga dan 5ung- d- )-dang Jam-nanK**a'an<
+. Seretar"at T"!
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TUA8S D8N N8NA
A T*as -a# 9e7e#a# e7a#Pe!'&"$a#a# Kl&s
D*=an P*r'-m)angan K(-n- )*r-5a'-nd*p*nd*n da(am p*ngam)-(an
%*pu'uanna dan )*rd-r- *)aga- p-a%-mpar-a( dan )*%*r4a *&ara )*%'-5<
Da(am P*(a%anaan 'ugana, D*=an dapa'm*m-n'a p*ndapa'/ mau%an dar- para a(-
*ua- a'au r*(*8an d*ngan maa(a %(-n-ang m*n4ad- *ng%*'a<
D*=an m*(a%u%an p*n*(*a-an *ng%*'adapa' m*m)*r-%an r*%m*nda- %*padaM*n'*r- K**a'an
D*=an )*r'an un a=a) dan m*n am a-%an
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en+uung Penguatan S"ste! (2)
e!antau +an !en+rng +"'entunya clinical pathway
&elayanan !e+" yang +"'uat le$ rgan"sas" &res"
+an/atau as"l"tas &elayanan ese$atan se'aga"unsur/a
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2< P*n*(*a-anS*ng%*'a K(-n-
M*(a%u%an p*n*(*a-an *ng%*'a%(-n- ang )*r-5a' na-na( danp*n*(*a-an *ng%*'a %(-n- ang
'-da% dapa' d-*(*a-%an (* T-mP*r'-m)angan K(-n-<
M*(a%u%an p*ndamp-ngan '*radap T-mP*r'-m)angan K(-n- un'u% p*n*(*a-an*ng%*'a d- '-ng%a' Pr8-n-
eenang Dean Pert"!'angan #l"n"s:
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eenang Dean Pert"!'angan #l"n"s:
aBe!%))!-as& -e#a# K)"&'e Pe#&la&a# Te%#)l)&Kese+a'a# :Healthe!hnolo"y #ssesment ; T&" Ta!& JKN T&" M)#&')!-a# E5al*as& T&" Pe#ea+a# F!a*- -ala" .e"$e!&a#!e%)"e#-as& *".a# $al&% -a# *s*la# .!&)!&'as %e.a-aMe#'e!& Kese+a'a# se$aa& *.a,a "e#-*%*#'e!la%sa#a#,a %e#-al& "*'* -a# %e#-al& $&a,a -ala"
JKN
$Me"as&l&'as& %))!-as& %e$&(a%a# .e#,ele#a!aa# JKN ,a# -&+as&l%a# *#&'
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eenang Dean Pert"!'angan#l"n"s:
*< M*ng*n'-%an dan/a'au m*(an4u'%an pr*p*m*r-%aan %au*ng%*'a<
d< M*nuun 4ad=a( p*m*r-%aan dan p*n-dangan%au *ng%*'a<
5
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5
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#eelasan #eenangan
P*mu'u *ng%*'a R*%m*nda'r 4ad-'ma'- *%*%u'r-a( *ua-%*=*nanganna
!ana g %uu g 8-a M*n%*
ung- )g ma4*(-/ma%ama7 m-r-pa%-m r -mpar-a( -nd*p*nd*n Fm*m-(-%- ur-d-%-7/%*%uaaan%*ma%amaan '*r*nd-r-
B*r4*n4ang, d-)a'a- )and-ng7 1 %a(- +''a( @ 2
'aap. SOP u'% pr* m*m)ua' pu'uan %au
p*dmanm-r-p u%um a&ara7
P-a% g '*rp*r-%a @ )*ra% d-damp-ng-
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atatan : OUTPUT Dean Pert #l"n#e!eng"atan Putusan :
D*=an P*r' K(-n Na d-ang%a' (*M*n%*
T-m P*r' K(-n @ / M*n%* +p*4a)a'%*m%* d- prp7 *ua- 2>/1 ''g
O'da G p-mp-nan da*ra/Kad-n%* a/nM*n%*
E%*%u- 8-a a'aan7 p-a% '*r%*na @
Dr 8-a TKMKB, a'au 8-a RS/KTLa'au KTP, a'au 8-a IDI/MKEK
BPJS da / BPJS Pua'
Pa-*n d-pu'u%an
ADA “ASAS PRESEDEN”/YURISPRUDENSI UTK
EFEKTIVITAS & EFISIENSI
+ T" P t" ' #l" "
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ugas +an eenang T"! Pert"!'angan #l"n"s
T*as T&" Pe!'&"$a#a# Kl&s a-ala+
M*n*(*a-%an *ng%*'a )*rdaar%an aduanang '*r4ad- d- =-(aa pr8-n- *'*mpa'<
M*ru4u% *ng%*'a ang '-da% dapa' d-*(*a-%an
d- '-ng%a'pr8-n- %*pada D*=an P*r'-m)angan K(-n-<
M*(apr%an *ng%*'a ang a%an d-'angan-,'*rmau% pr* p*r%*m)angan dan
p*n*(*a-anna %*pada D*=an P*r'-m)anganK(-n-<
M*m)an'u D*=an P*r'-m)angan K(-n- da(amp*ngumpu(an )aan?)aan p*ndu%ung a'au
p*ndamp-ngan p*n*(*a-an *ng%*'a un'u%
eenang T"! Pert"!'angan #l"n"s:
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eenang T"! Pert"!'angan #l"n"s:
M*ng*n'-%an pr* p*m*r-%aan aduan ang '-da%m*m*nu-
ara' *ua- m*%an-m* p*ng*n'-an aduan<
M*(a%u%an p*m*r-%aan, -n8*'-ga-, m*mangg-( danm*m-n'a %*'*rangan a%-/a(-<
M*m*r-%a d%um*n/ura'?m*nura', da'a -n5rma-*(*%'rn-%
+d-g-'a(. dar- para p-a% dan r*%am m*d- %**a'an'*r%a-'<
M*ndapa'%an da'a %(a-m ang d-a4u%an 5a-(-'a
%**a'an %* BPJS K**a'an< M*mangg-( dan m*m-n'a %*'*rangan *r'a
m*m*r-%a d%um*n/ura'?m*nura', da'a -n5rma-*(*%'rn-% +d-g-'a(. a%-/a(- dar- T-m Mn-'r-ng dan
E8a(ua-, T-m P*n&*gaan raud, T-m K*nda(- Mu'udan K*nda(- B-aa, D*=an P*r'-m)angan M*d-%,
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eenang T"! Pert"!'angan #l"n"s:
M*m)ua' %*pu'uan p*n*(*a-an *ng%*'adan m*nguu(%an p*n*'apanna %*padaD*=an P*r'-m)angan K(-n- un'u% %au ang)aru *(am)a'?(am)a'na 1 +a'u. )u(an *4a%d-mu(a-na p*m*r-%aan<
M*m)ua' %*pu'uan p*n*(*a-an *ng%*'a%au *4*n- ang '*(a d-'*'ap%an (*D*=an P*r'-m)angan K(-n- *(am)a'?(am)a'na 2 +dua. m-nggu<
M*(apr%an %*pu'uan ang d-am)-()*rdaar%an %*'*'apan D*=an P*r'-m)anganK(-n- *&ara )*r%a(a *(am)a'? (am)a'na*'-ap 2 +dua. )u(an d*ngan '*m)uan %* D-naK**a'an Pr8-n-<
M*nd%um*n'a-%an %*pu'uan p*n*(*a-an
Tugas Seretar"at Dean Pert"!'angan #l"n"s
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Tugas Seretar"at Dean Pert"!'angan #l"n"s
M*m)an'u P*(a%anaan 'uga D*=an P*r'-m)anganK(-n-
T*rd-r- dar- n-' '*r%a-' d- K*m*n'*r-an K**a'an<
Tuga *%r*'ar-a' ada(a@1< M*(a%u%an %*g-a'an adm-n-'ra- da(am rang%a
m*ndu%ung %*g-a'an D*=an P*r'-m)angan K(-n- da(amm*n4a(an%an 'uga dan =*=*nangna '*rmau%p*nuunan anggaran %*g-a'an p*ra-na(<
2< M*ng-n8*n'ar-a- dan m*ng%mp-(a- *ng%*'a '*r%a-' JKN )a-% ang '*(a, *dang dan/a'au )*(um d-*(*a-%an,
ang d-(apr%an (* T-m P*r'-m)angan K(-n-<>< M*nuun da5'ar *ng%*'a %(-n- ang a%an d- *(*a-%an
(* D*=an P*r'-m)angan K(-n-<
< M*ng-n8*n'ar-a- dan m*ngmp-(a- %*pu'uanp*n*(*a-an *ng%*'a ang d-a-(%an (* D*=anP*r'-m)angan K(-n- dan T-m P*r'-m)angan K(-n- *)aga-)aan p*m)-naan<
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Tugas Seretar"at T"! Pert"!'angan #l"n"s
B*r%*dudu%an d- D-na K**a'an Pr8-n-< D-(a%ana%an (* '*naga adm-n-'ra'-5 dar-
unur T-mMn*8 dan P*r'-m)angan K(-n-<
Tuga *%r*'ar-a' ada(a@1< M*(a%u%an %*g-a'an adm-n-'ra- da(am rang%am*ndu%ung %*g-a'an T-m P*r'-m)angan K(-n-da(am m*n4a(an%an 'uga dan =*=*nangna'*rmau% p*nuunan anggaran %*g-a'anp*ra-na(<
2< M*ngumpu(%an, m*ng-n8*n'ar-a-, danm*ng%mp-(a- *mua p*ngaduan '*r%a-' JKN angmau% %* T-m P*r'-m)angan K(-n-<
>< M*nuun da5'ar *ng%*'a %(-n- ang a%an d-*(*a-%an (* T-m
P*r'-m)angan K(-n-<< M*(a%ana%an *nd%um*n'a-an %* -a'an T-m
MEKANISME KERJA
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1. 8lur #era en+uung Penguatan S"ste!
Kmp-(a- da'a dan-n5rma- *ng%*'aKa)upa'*n/K'a/Pr8-n
-
T*(aa %r-'- dan/a'auana(-- %*)-4a%an (*
D*=an P*r'-m)anganK(-n-
R*%m*nda-H
Km-'* PTK, T-m Tar-5 JKN, T-m Mn*8, T-mP*n&*gaan raud,MKEK pua' dan BPRS
P**r'a, rgan-a- pa-*n,a-a- 5a%*, rgan-a-pr5*-, p*m*r-n'a da*radan p*mang%u %*p*n'-ngan
(a-n
mpan)a(-%
R*%m*nda- %*padaM*n'*r- K**a'an, BPJS
K**a'an, dan p-a%?p-a%
p*mang%u %*p*n'-ngan (a-n
MEKANISME KERJA
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D*=an P*r'-m)angan K(-n- )*rama BPJSK**a'an 4uga m*(a%u%an ana(-- %*)-4a%an'*radap A(a' K**a'an/O)a' ang dapa'd-%(a-m '*rp-a dar- Pa%*' Indn*-an :a*Ba*d "rup +INA :B";. da(am %nd--
%uu un'u% %**(ama'an pa-*n %mp-(a-da'a dan -n5rma- *ng%*'a '*n'ang A(a'K**a'an/)a' '*r*)u' dar- *(uru%a)upa'*n/%'a
A(a' K**a'an/)a' d-ma%udan'ara (a-n@ A(a' %**a'an ang 5ung-na m*m)an'u a(a'
%**a'an u'ama ang m*n4ad- ara' mu'(a%a'au %mpn*n p*n'-ng/**n-a( ang '*rp-adar- a(a' %**a'an u'ama/)a' ang d-)u'u%anpa-*n<
A(a' %**a'an ang 4um(ana *&ara m-n-mumd- *r(u%an un'u% m*(a%ana%an '-nda%an *ua-
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#8NS #*J8
Al*! Ke!(a Pe#,elesa&a# Se#%e'a
S*ng%*'a dapa' '*r4ad- an'ara @ a-(-'a K**a'an d*ngan BPJS K**a'an,
a-(-'a K**a'an d*ngan p**r'a JKN, BPJS K**a'an d*ngan p**r'a JKN<
D-(a%u%an *&ara )*r4*n4ang dar- '-ng%a'pr8-n- ampa- d*ngan pua'
Pr-n-p P*n*(*a-an *ng%*'a@ K*ad-(an, AaMan5aa', E5*%'-5, dan E9-*n
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A(ur K*r4a P*n*(*a-an S*ng%*'a
Da(am a( *ng%*'a d- '-ng%a'
%a)upa'*n/%'a uda dapa' d-*(*a-%an(* TKMKB dan/a'au DPM, T-mP*r'-m)angan K(-n- Pr8-n- *'*mpa'(angung m*ng%mp-(a- *ng%*'a '*r*)u'
m*(a(u- *%r*'ar-a' T-m P*r'-m)angan K(-n- d-'*ru%an %*pada D*=an P*r'-m)anganK(-n- m*(a(u- *%r*'ar-a' D*=anP*r'-m)angan K(-n-<
P*n*(*a-an S*ng%*'a d-mu(a- dar-d-'*r-mana aduan r*m- para p-a% angmau% %* *%r*'ar-a' T-m P*r'-m)anganK(-n-
S*(uru pr* p*m*r-%aan dan
A(ur K*r4a P*n*(*a-an S*ng%*'a
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A(ur K*r4a P*n*(*a-an S*ng%*'a
K*pu'uan ang )*r-5a' 9na( dan '*'ap dapa'd-)ua' (* T-m P*r'-m)angan K(-n- *'*(a
para p-a% m*na'a%an m*n*r-ma +'-da%)and-ng.
Apa)-(a '*rdapa' upaa )and-ng, pu'uan ang)*r-5a' 9na( dan '*'ap aru d-)ua' (*
D*=an P*r'-m)angan K(-n-<P*m)a&aan %*pu'uan *ng%*'a =a4-) d-ad-r-para p-a%, namun T-m a'au D*=anP*r'-m)angan K(-n- dapa' m*m)a&a%an
%*pu'uan *&ara in absentia.
D*=an P*r'-m)angan K(-n- m*(a%u%anp*m)-naan dan *8a(ua- dar- a-( %mp-(a-dar- *%r*'ar-a' T-m P*r'-m)angan K(-n- dan*%r*'ar-a' D*=an P*r'-m)an an K(-n- un'u%
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Sans" Putusan Penyelesa"an
Sengeta
T*radap BPJSK )aar %(a-m, u)a%*)-4a%an
'*%n-
T*radap K*mK* u)a %*)-4a%an,ang '*r'u4u %*pada @ T-m !TA, T-mAn'- raud, TKMKB, MKEK, OP, dan T-m?'-m (a-nna<
T*radap Pr8-d*r D%'*r R:A -ngga%* d-agn- a=a(
T*radap Pr8-d*r KTP dan KRTL
T*radap pa-*n
Pe#a-*
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!a-*
a# Kl&sP!)5s&
Pe!'&"$a#a# Kl&sS*ng%*'a d- a%*
da(amP*n*(*nggaraan
JKN
P*ngaduan *&ara '*r'u(-dar- p*ngadu d-'*r-ma(* S*%r*'ar-a' T-m
P*m*r-%aK*)aan
para p-a%
D-(a%u%anP*m*r-%aan
T-ng%a' P*r'ama
'*radapP*ngaduan
Lapran P*ngaduan dar- T-md-'*r-ma (* S*%r*'ar-a'D*=an
P*m*r-%aK*)aan
para p-a%
D-(a%u%anP*m*r-%aan
T-ng%a' Band-ng
'*radapP*ngaduan
P*ngaduan *&ara'*r'u(- dar- P-a%
angB*r*ng%*'a
Band-nga'aPu'uan
T-mH K*pu'uan
P*n*(*a-anS*ng%*'a T-mP*r'-m)angan K(-n-
K*pu'uanP*n*(*a-an
S*ng%*'aLapran P*ngaduanm*ng*na- *ng%*'aang '-da% dapa'
d-*(*a-%an
K*pu'uanP*n*(*a-an
S*ng%*'a D*=anP*r'-m)angan
K(-n-
adaPu'uan
T-mH
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K*'ua T-m P*r'-m)anganK(-n- d-)an'u
*%r*'ar-a' m*ng*&*%
%*a)aan para p-a%
K*pu'uanP*n*(*a-anS*ng%*'a T-mP*r'-m)angan
K(-n-
K*'ua T-m P*r'-m)anganK(-n- )*rama angg'a
m*m*r-%a p-a%P*ngadu
K*'ua T-m P*r'-m)anganK(-n- )*rama angg'a
m*m*r-%a p-a% T*radu
K*'ua T-mP*r'-m)angan K(-n-
)*rama angg'aapa)-(a d-p*r(u%anm*m*r-%a p-a%?p-a%'*r%a-' un'u% d-4ad-%an)aan p*r'-m)angan
K*'ua T-m P*r'-m)anganK(-n- )*rama angg'a
m*(a%u%an -dang
un'u% m*m)ua'%*pu'uan
AdaPu'uan T-mH
Lapran P*ngaduanm*ng*na-
*ng%*'a ang'-da% dapa'd-*(*a-%an
ean"s!e Pe!er"saan T"ngat %an+"ng
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ean"s!e Pe!er"saan T"ngat %an+"ng
K*'ua D*=anP*r'-m)angan K(-n-d-)an'u *%r*'ar-a'
m*ng*&*% %*a)aanpara p-a%
K*pu'uanP*n*(*a-an
S*ng%*'a D*=anP*r'-m)angan
B(-n-
K*'ua D*=an P*r'-m)anganK(-n- )*rama angg'a
m*m*r-%a p-a% P*ngadu
K*'ua D*=an P*r'-m)anganK(-n- )*rama angg'am*m*r-%a p-a% T*radu
K*'ua D*=an P*r'-m)anganK(-n- )*rama angg'a
apa)-(a d-p*r(u%anm*m*r-%a p-a%?p-a%'*r%a-' un'u% d-4ad-%an)aan p*r'-m)angan
K*'ua D*=anP*r'-m)angan K(-n-
)*rama angg'am*(a%u%an -dang un'u%
m*m)ua' %*pu'uan
D"larang +"+a!&"ng" &enga
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%e'era&a Te!&late Penyelesa"an Sengeta
:(-n-&a( "u-d*(-n* :(-n-&a( A(gr-'ma
Imp(-%a- :'-ng ?
m*ng-%a'
Pela&ran
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Pela&ran
T-m P*r'-m)angan K(-n-
T-m P*r'-m)angan K(-n- m*nuun (apran %*pada D*=anP*r'-m)angan K(-n- ang '*rd-r- dar- @
Lapran *ng%*'a ang a%an d-*(*a-%an
Lapran pr* p*n*(*a-an ang *dangd-*(*a-%an
Lapran *ng%*'a ang '*(a d-*(*a-%an Lapran *ng%*'a ang '-da% dapa'
d-*(*a-%an
D*=an P*r'-m)angan K(-n-
Lapran %*pu'uan p*n*(*a-an *ng%*'aun'u% d-'*'ap%an M*n'*r-
Lapran umpan )a(-% p*n*(*a-an *ng%*'apada T-m
P*r'-m)angan K(-n-
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Pen+anaan Dana ang d-p*r(u%an un'u% p*(a%anaan
p*r'-m)angan K(-n- )a-% d- Pua' maupun d-Pr8-n- d-)*)an%an %*pada AnggaranP*ndapa'an dan B*(an4a N*gara<
P*ndanaan un'u% %*g-a'an P*r'-m)angan K(-n- d-
'-ng%a' pua' )*raa( dar- DIPA Pua' P*m)-aaandan Jam-nan K**a'an<
S*)*(um dana '*r*)u' d-a(%a-%an *&ara '*'ap,un'u% %*g-a'an p*r'-m)angan %(-n- d- '-ng%a'pr8-n-, p*m)-aaan )*rum)*r dar- dana
D*%n*n'ra- Op*ra-na( T-m Mn*8 danP*r'-m)angan K(-n- JKN Pr8-n-<
M*%an-m* p*m)-aaan p*(a%anaanP*r'-m)angan K(-n- pada Pr8-n- m*nga&u pada
P*'un4u% T*%n- Dana D*%n*n'ra- Prgram
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#es"!&ulan
De Pert #l"n +"$ara&an !a$a!a$ "!&ars"al "n+e&en+en sengeta J#N s'g u&aya a$"r +" eenangan
eseut" es +"tenga$ ungs" le!'aga/un"t s&t : %P*S T"!
8nt" rau+ T"! tar" T"! ?T8 DP T##% %PJS !au&un
!ael"s et"a/+"s"&l"n &res"
Sengeta l"n"s +l! art" luas se&anang !enyangut tr"&art"t : %PJS E &rC"+er es &as"en
Tugas a+a 2 la"n sela"n !a$a!a$ +"lanutan +g ungs" F
eenangan !as"ng!as"ng
#eanggtaannya : SD !&eten (terlat"$) F tere
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n'u% Indn*-a ang (*)- *a'
MIN N
KESEH T
N
N SION L