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Journal : Jurnal Preventia

A Position Analysis of BPJS Claims Administration Officers and Verifiers (Case Study: Jambi Province Regional Mental Hospital) Hanisah, Hanisah; Ainy, Asmaripa; Budi, Iwan Stia
Preventia : The Indonesian Journal of Public Health Vol 8, No 2 (2023)
Publisher : Universitas Negeri Malang

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.17977/um044v8i22023p39-46

Abstract

The high coverage rate of handling partially rejected claim financing reaching 7.34% of the total 19,476 cases in the Outpatient Unit of the Jambi Provincial Mental Hospital (RSJD) in 2022, is closely related to the quality of human resources (HR) in this case, the claims officer and the suitability of what is done with the job description, job specifications and standard operating procedures (SOP) that have been made. This study aimed to analyze the position of administrative officers and claim verifiers in the outpatient unit of the Jambi Provincial Mental Hospital. This research used a qualitative method. Information was collected through in-depth interviews with eight informants, observation, and document review. Test validity by triangulating sources, techniques, and data. The results showed that officers already knew the claims administration and verification procedures. The claim administration SOP in this case, the RJTL claim submission SOP and the monthly reporting SOP have not been outlined in a decision letter for the coding SOP. However, it has been outlined in a decision letter but has not been adequately socialized to the officers concerned. The SOP for claim verification has not been outlined in a decision letter and still refers to the technical guidelines for claim verification issued by BPJS Health. It is still found that the delegation of tasks and the number of verification officers not following the calculation of workload and standards set are obstacles in implementing administration and verification of claims in the Jambi Province RSJD outpatient department.
Co-Authors Acha, Basyarudin Adek Puja Wiyanda Adiansyah Adiansyah, Adiansyah Adnan Adnan Agus Putra AS Ahmad Ridwan Aini, Annisa Quratul Amilda, Yenni Aminuyati Anita Primastiwi Antonius Budi Susanto anzitha, silvia Ariska, Raja Novi Asmaripa Ainy Basriwijaya, Kiagus Muhammad Zain Bhisma Murti Chania Mely Piana Dewi Kusuma Wardani Dewi, Ismala dianawati, dianawati Evenda, Nur Aisyah Fadila, Nelly Dewi Fadli Fadli Fadly, Fahmy Fairus, Fairus Fauzan Isma, Muhammad Febri, Suri Purnama Fiddini Alham Fionari, Gebi Ginting, Adetta Saskia gustiana, cut Haikal, Echa Handayani, Anggun Fitri Harahap, Antoni Haser, Teuku Fadlon Husna, Hayatul Ika Rezvani Aprita Imran Imran indra, siti balqies Iwan Hasri Iwan Stia Budi Juanda, Boy Riza Juanda, Boy Riza Khairullah, T. Fajar Lusiana, Ela Mahyuddin, Thursina Maradona , Maradona Moh Sutomo, Moh Muhammad Zain Basriwijaya, Kiagus Mulyani, Cut Nazlia, Suraiya Nur Meria Agustin Prasetia, M Bayu Putri, Nasywa Tania Putriningtias, Andika Rachmawati Rusydi, Rachmawati Radhiah, Radhiah Rahman, Arizky Ramli, Satria Ridha, Risky Rini Mastuti Risyad, Syukri Saihan, Saihan Sakdiah, Muslimatus salamah salamah Sanoviq, Rizky Moela Santi, Fitriana Saputra, Iwan Sari, Nurdian Novita Sastria, Andi Siregar, Noviandri Ramadhani Siregar, Rinawati Siti Balqies Indra Siti Komariyah SUHARI, LILI Sukma, Detta Ananda Syahputra, Masadjie Syahriandi Syahriandi Teuku Muhammad Faisal, Teuku Muhammad Thursina Mahyuddin Umar Umar Wijayanti, Dwi Nina Wulandari, Hafizah Tri Yoan Purbolingga Zulhilmi, Zulhilmi