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All Journal Jurnal Mahasiswa Ilmu Kesehatan
Devira Ulfah Meilani
Politeknik Piksi Ganesha
Health Professions Nursing Public Health

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ANALISIS KUNJUNGAN BERULANG PASIEN LAMA RAWAT JALAN TERHADAP PENDING KLAIM BPJS KESEHATAN DI RUMAH SAKIT MUHAMMADIYAH BANDUNG Devira Ulfah Meilani; Desy Widyaningrum
Jurnal Mahasiswa Ilmu Kesehatan Vol. 4 No. 3 (2026): Jurnal Mahasiswa Ilmu Kesehatan
Publisher : STIKes Ibnu Sina Ajibarang

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.59841/jumkes.v4i3.3981

Abstract

Repeated outpatient visits by patients without a clear medical indication contribute to pending claims from BPJS Kesehatan. Based on initial observations at RS Muhammadiyah Bandung, it was found that repeated visits are one of the main reasons for outpatient claims being pending each month. This study aims to analyze the pattern of repeated outpatient visits related to BPJS Kesehatan pending claims and their impact on claims management. The study uses a descriptive qualitative method. Research results show that out of 469 outpatient claims that were pending during the first quarter of 2026, 111 claims were due to repeated visits. Of that number, 82 claims were resubmitted, while 29 claims could not be resubmitted because the diagnosis remained the same without any new treatment, so they were considered follow-up or check-up visits only. It is concluded that repeated visits contribute to pending claims, but there is a need to strengthen documentation and develop an automatic detection system.
Co-Authors Desy Widyaningrum