Background: The X Public Hospital tariff that deals with diseases catastrophic lower than claims INA-CBGS, this is likely to the hospital in case of encountering the universal health coverage at 2019. Research objective: the difference management costs catastrophic between claims INA-CBGs and the expense of the costs at the X Public Hospital. Methods: the research is based on the descriptive qualitative research with case study by using the primary and secondary data. The research object is the tariff of X Public Hospital in Mataram and cost of INA-CBGs claim, based on Case-Unit. The research subjects are the quality control and cost control team (TKTMB), the coder team, the Financial Department of Health Insurance Claim (IKJK), the doctor in charge of the patient (DPJP) who treat the patient with the Diagnosis during January - June 2017. Result: There is difference of real tariff with INA-CBGs package rate and there are variations in service delivery high cost in X Public Hospital, Mataram 2017. Conclusions: implementation of clinical pathways as one as measure of efficiency in care service, evaluate unit cost every period as base in tariff arrangement. Keywords: Cost analysis, Catastrophic care, Casemix systems, Clinical pathway