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All Journal Infokes : Jurnal Ilmiah Rekam Medis dan Informasi Kesehatan
Nik Azliza Nik Ariffin
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Health Professions Medicine & Pharmacology Nursing Public Health Veterinary

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Design of a Web-Based Internal Claim Audit Application in the Casemix Unit in a Hospital to Minimize Pending Claims Yastori Yastori; Nurul Fitri Khumaira; Muhammad Kaddafi Suyatno; Nik Azliza Nik Ariffin
Jurnal Infokes Vol 16 No 1 (2026): Jurnal Ilmiah Rekam Medis dan Informatika Kesehatan
Publisher : Universitas Duta Bangsa Surakarta

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.47701/yb89e038

Abstract

The Casemix Unit plays a strategic role in the submission and reimbursement of healthcare service claims for BPJS Kesehatan participants. Nevertheless, many hospitals continue to experience pending claims due to administrative errors, incomplete documentation, coding inaccuracies, prolonged verification processes, policy changes, and limited integration of information systems. This study aimed to design and evaluate a web-based internal claim audit application to improve verification effectiveness and reduce pending claims in the Casemix Unit. This research adopted a Research and Development (R&D) approach using the Borg and Gall model and was conducted over one year at RSU Prof. Dr. M. A. Hanafiah Batusangkar, where an increasing number of pending claims was identified in 2024. System evaluation was carried out through usability assessment, and comparative observation of the claim audit process before and after prototype implementation. The results demonstrated that all application features functioned according to system requirements. Implementation of the application contributed to improved operational efficiency, enhanced accuracy in document and coding verification, and faster claim review time compared to the previous manual process. The application includes document completeness verification, coding validation, claim status monitoring, and AI-assisted early detection of potential errors with corrective recommendations. These findings indicate that the system is feasible and capable of supporting a more structured and consistent internal audit process. The study concludes that the application has strong potential to improve claim management quality and support hospital financial sustainability. Future studies should conduct broader implementation, integrate the system with hospital information systems and BPJS platforms, and perform long-term quantitative evaluations of its effectiveness.
Nurses’ Role in Completing Anamnesis Supporting Coding of External Cause Injury Diagnoses Andi karisma Nurdiyansyah; Deby Zulkarnain Rahadian Syah; Ida Aninda; Ragil Lintang Juliana; Gebi Yulanda; Piping Asgiani; Nik Azliza Nik Ariffin
Jurnal Infokes Vol 16 No 1 (2026): Jurnal Ilmiah Rekam Medis dan Informatika Kesehatan
Publisher : Universitas Duta Bangsa Surakarta

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.47701/hy0has42

Abstract

The accuracy of ICD-10 external cause injury coding depends heavily on the completeness of anamnesis documentation, particularly information on event chronology, place of occurrence, and patient activity. Nurses, as primary healthcare professionals responsible for anamnesis documentation in the Emergency Department (ED), play a key role in supporting accurate diagnostic coding. However, incomplete documentation of external cause injury information remains a common challenge in hospital settings. This study aimed to analyze the role of nurses in ensuring the completeness of external cause injury anamnesis to support accurate diagnostic coding at Mitra Paramedika Hospital, Yogyakarta. A qualitative descriptive study with a case study approach was conducted involving 12 healthcare workers, consisting of 10 emergency nurses and 2 medical record coders. Data were collected through pre-tests, focused group discussions (FGDs), post-tests, medical record observations, and in-depth interviews. Descriptive analysis was used to assess changes in knowledge and documentation practices before and after the intervention. The results indicated that prior to the FGD, several nurses had limited understanding of the importance of documenting place of occurrence and patient activity for external cause coding. Following the FGD, all participants demonstrated adequate knowledge in the post-test. Additionally, the use of electronic medical records improved documentation readability and completeness, facilitating more accurate coding. This study concludes that nurses play a critical role in external cause injury documentation, and that educational interventions and electronic medical record implementation effectively enhance documentation quality and coding accuracy.
Co-Authors Deby Zulkarnain Rahadian Syah Gebi Yulanda Ida Aninda Muhammad Kaddafi Suyatno Nurdiyansyah, Andi Karisma Nurul Fitri Khumaira Piping Asgiani Ragil Lintang Juliana Yastori Yastori