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All Journal Innofarm : Jurnal Inovasi Pertanian Jurnal Manajemen Informasi dan Administrasi Kesehatan Journal of Epidemiology and Public Health Indonesian Journal of Global Health research Jurnal Ilmu Kesehatan Masyarakat Berkala IJECS: Indonesian Journal of Empowerment and Community Services Journal of International Conference Proceedings The Journal of Educational Development Strada Jurnal Ilmiah Kesehatan (SJIK)
Rahardjo, Budhi
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Religion Agriculture, Biological Sciences & Forestry Humanities Computer Science & IT Decision Sciences, Operations Research & Management Dentistry Earth & Planetary Sciences Education Electrical & Electronics Engineering Environmental Science Health Professions Industrial & Manufacturing Engineering Languange, Linguistic, Communication & Media Medicine & Pharmacology Nursing Public Health Social Sciences

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Journal : The Journal of Educational Development

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Educational Interventions and Digital Innovation for Improving BPJS Inpatient Claims Maulia, Putri; Sartika , Iik; Ani, Nur; Rahardjo, Budhi
The Journal of Educational Development Vol. 13 No. 1 (2025): June 2025
Publisher : Universitas Negeri Semarang

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.15294/jed.v13i1.24372

Abstract

Pending inpatient claims under Indonesia’s National Health Insurance (BPJS Kesehatan) have become a critical concern for hospital financial management and administrative performance, particularly as hospitals transition to digital claim systems. This study aims to investigate the effectiveness of educational interventions and digital innovation in reducing pending BPJS inpatient claims, while providing actionable policy insights to improve hospital claim management. Employing a descriptive quantitative approach, the research utilizes secondary data from all inpatient claim submissions at RS Slamet Riyadi Surakarta for October 2024, complemented by internal audits and stakeholder interviews. The urgency of this study arises from the persistent delays in claim processing, which threaten both hospital cash flow and service sustainability. The findings reveal that inaccurate medical records constitute the most significant factor contributing to claim delays, accounting for 75% of pending cases, followed by incomplete documentation, insufficient supporting examinations, and inadequate therapeutic evidence. Novelty emerges through the systematic prioritization of delay determinants and the application of structured educational interventions and AI-based digital tools to enhance staff competence and verification processes. The research contributes practical recommendations for integrating ongoing education, digital verification, and collaborative policy-making, thereby strengthening the quality, transparency, and efficiency of BPJS inpatient claim management in Indonesian hospitals.
Co-Authors Adi Sujarwo Desy Kurnia Putri Dina Ayu Lestari, Dina Fitrianingrum Kurniawati, Fitrianingrum Maharani, Nine Elissa Maulia, Putri Munika Saraswati Nugraho, Farid Setyo Nugroho, Farid Setyo Nur Ani Nur Ani Puji Hastuti Rini Widaningsih Sartika , Iik Suryo Ediyono Suryo Ediyono Syefira Ayudia Syefira Ayudia Johar Titik Haryanti Tursina, Elsa Ulfah, Hana Rosian Utami, Amrih Gancar Wartini Wartini Wartini Wartini, Wartini