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All Journal Media Kesehatan Masyarakat Indonesia Jurnal Kebijakan Kesehatan Indonesia Disease Prevention and Public Health Journal Jurnal Administrasi Kesehatan Indonesia Journal of Agromedicine and Medical Sciences Jurnal Kesehatan Jurnal Preventia Jurnal Gizi Klinik Indonesia Jurnal Kesehatan Komunitas Jurnal SOLMA Jurnal Manajemen Kesehatan Yayasan RS.Dr. Soetomo Jurnal Kesehatan Prima Jambura Journal of Health Sciences and Research Seminar Nasional Keperawatan Medical Technology and Public Health Journal Jurnal Ilmiah Kesehatan KESMAS UWIGAMA: Jurnal Kesehatan Masyarakat PUBLIKASI PENELITIAN TERAPAN DAN KEBIJAKAN Jurnal Ilmiah Kesehatan Masyarakat : Media Komunikasi Komunitas Kesehatan Masyarakat Jurnal Pengabdian Masyarakat: Humanity and Medicine J-REMI : Jurnal Rekam Medik dan Informasi Kesehatan Gemakes: Jurnal Pengabdian Kepada Masyarakat JUMANTIK (Jurnal Ilmiah Penelitian Kesehatan) Borneo Community Health Sevice Journal Journal of Public Health and Pharmacy GEMASSIKA: Jurnal Pengabdian kepada Masyarakat Kesmas: Jurnal Kesehatan Masyarakat Nasional (National Public Health Journal) Jurnal Ilmu Kesehatan Masyarakat
Asmaripa Ainy
Fakultas Kesehatan Masyarakat Universitas Sriwijaya
Agriculture, Biological Sciences & Forestry Biochemistry, Genetics & Molecular Biology Chemistry Dentistry Economics, Econometrics & Finance Education Environmental Science Health Professions Medicine & Pharmacology Nursing Physics Public Health Social Sciences Other

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Journal : Jurnal Preventia

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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 Achmad Fickry Faisya Achmad Fickry Faisya, Achmad Fickry Adelina Fitri Adinda Intan Pratiwi Akila Labiba Alta Fatra Alta Fatra, Alta Alvera Noviyan Alvera Noviyani Amrina Rosyada Amrina Rosyada Andodi Andodi, Andodi Ani Nidia Lisianti Anita Camelia Anita Rahmiwati Annisa Rahmawaty Annisa Rahmawaty Arie Kusumaningrum Asri Maharani Azmi, Zahidah Mursyidah Bambang Irawan Chendra, Rudy Des Mery Des Mery, Des Desri Maulina Dian Safriantini Dian Safriantini Dian Safriantini Dian Safriantini Dian Safriantini, Dian Elvara Angelita Elvi Sunarsih Erliande Feswenti Erliande Feswenti, Erliande Erma Kartikasari Fajar, Nur Alam Fatmalina Febry Fatmalina Febry Fatmalina Febry Feby Happy Monica Feby Happy Monica, Feby Happy Fenny Etrawati Fujiyanti, Poppy Ghita Apriani Haerawati Idris Haerawati Idris Haerawati Idris, Haerawati Hamzah Hasyim Hanisah, Hanisah Hartati Inaku Herman Brawijaya Herman Brawijaya, Herman Indah Dwi Wahyuni Indah Dwi Wahyuni, Indah Dwi Indah Fasha Palingga Irawan, Bambang Iwan Stia Budi Iwan Stia Budi Jumatra Laila Kartikasari, Erma Kaulam Miryanti Kaulam Miryanti, Kaulam Laila, Jumatra Lisianti, Ani Nidia Lubis, Adelina Irmayani Magdalena Magdalena Maharani, Kaisa Davina Maulina Sari, Desri Misnaniarti Misnaniarti Misnaniarti Misnaniarti Misnaniarti Misnaniarti Monica Aprilla Andestri Muhammad Pandu Aditya Najmah Najmah Najmah, Najmah Nur Alam Fajar Nur Alam Fajar Nur Alam Fajar Nur Alam Fajar Nurmalia Ermi Pujiyanto Pujiyanto Putri Ayu Nurhaliza Putri Widita Muharyani Rahayu, Rizka Sri Resi Hartini Resi Hartini, Resi Reztia Handayani, Reztia Rini Andriani Rini Andriani Rini Mutahar Ririn Yaumil Pratiwi Ririn Yaumil Pratiwi, Ririn Yaumil Rizma Adlia Syakurah Rudy Chendra Sabri Sudirman Sarri, Merri Nurmala Sartika Sartika, Dewi Siti Halimatul Munawarah Stiyawan, Yonatan Suci Destriatania Taufiq, Fildzah Hashifah Tembo, Tannia Try Any Widyastuti, Try Any Utami, Adinda Satriavi Vaseta Eka Pardana Vaseta Eka Pardana, Vaseta Eka Virna Widora Saputri Virna Widora Saputri Widiati, Ilham Xaviera, Virnimuthia Yuni Masrona Zilfadila Zilfadila