In the digital era of healthcare, hospitals face increasing financial pressures, especially within Indonesia’s National Health Insurance (Jaminan Kesehatan Nasional - JKN) framework (14/10). AdMedika, a digital health subsidiary of PT Telkom Indonesia, emphasizes the crucial role of Third Party Administrators (TPAs) in supporting hospital business continuity and service quality enhancement.

Speaking at the National PERSI XXI Seminar, Patient Safety XIX, and Hospital Expo XXXVII in ICE BSD, Tangerang on 26 September 2025, AdMedika’s CEO Dian Prambini highlighted TPAs as strategic partners bridging hospitals and insurance providers, driving integrated and efficient service processes.

Enhancing Hospital-Insurance Collaboration through TPA Integration

Dian Prambini explained that TPAs streamline cooperation workflows between hospitals and insurers by integrating key functions. “Through TPA, the collaboration flow between hospitals and insurance becomes more integrated, starting from claim validation, administrative efficiency, management of service packages, to real-time claim monitoring,” she noted.

This integration not only speeds up payments but also optimizes clinical pathways and coordination of benefits (COB) with BPJS, Indonesia’s social health insurance. The result is improved cash flow and higher patient satisfaction, essential in a competitive healthcare environment.

Addressing Financial Challenges in Hospitals with TPA Partnerships

Hospitals often encounter declining service revenues coupled with complex administration that impede cash flow, threatening service sustainability. Dian stressed the importance of revenue diversification via collaboration with private insurance through TPAs.

“Some hospitals experience revenue drops and administrative complexity that block cash flow,” she said. “If left unchecked, this affects service continuity. Hospitals need to diversify income by optimizing partnerships with private insurance via TPAs, which can create wider opportunities to sustain services.”

Innovative Digital Solutions and Real-Time Monitoring by AdMedika

AdMedika’s strategy includes patient segmentation beyond JKN, digitalizing service processes, developing bundled tariff packages, and implementing transparency through real-time monitoring systems. These measures accelerate claim validation, minimize disputes, and boost satisfaction for both patients and insurance partners.

Driving Healthcare Quality and Financial Sustainability via TPAs

The overarching theme of the National PERSI XXI Seminar, “Improving Access, Quality, and Safety through Financial Sustainability,” underscores that hospital business sustainability depends on financing innovation. The hospital-TPA-insurance collaboration promoted by AdMedika addresses regulatory challenges, efficiency needs, and rising demands for quality healthcare in Indonesia.

PHOTO: TELKOM INDONESIA

This article was created with AI assistance.