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All Journal PROFESSIONAL HEALTH JOURNAL Jurnal Ilmu Kebidanan dan Kesehatan Jurnal Riset Rumpun Ilmu Kesehatan (JURRIKES)
Mertisa Dwi Klevina
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Health Professions Medicine & Pharmacology Nursing Public Health

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Journal : Jurnal Riset Rumpun Ilmu Kesehatan (JURRIKES)

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Reducing Pending Claims In Indonesia’s National Health Insurance System: Evidence From A Standardized Manual Administration Intervention Irmawati Mathar; Mertisa Dwi Klevina
JURNAL RISET RUMPUN ILMU KESEHATAN Vol. 4 No. 1 (2025): April : Jurnal Riset Rumpun Ilmu Kesehatan
Publisher : Pusat riset dan Inovasi Nasional

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.55606/jurrikes.v4i1.4825

Abstract

Pending claims in Indonesia’s National Health Insurance (JKN) system pose a significant challenge, affecting hospital cash flow and administrative efficiency. A high rate of pending claims is often caused by incomplete documentation, misfiled medical records, and delays in verification processes. Optimizing manual administrative procedures may provide a solution to this issue. This study aims to evaluate the effectiveness of a standardized manual administration model in reducing pending claims in a hospital setting. A quasi-experimental pretest-posttest design without a control group was employed. Data were collected from a referral hospital in Indonesia from July to September 2024. A total of 138 inpatient claims were selected using simple random sampling. The intervention involved implementing a standardized manual administration system in August and September. Statistical analysis was conducted using Fisher’s Exact Test with a significance level of p < 0.05. The implementation of the standardized manual administration model significantly reduced pending claims from 70.3% (97/138) in July (pre-intervention) to 36.2% (50/138) in August and further to 11.6% (16/138) in September (post-intervention) (p = 0.000 and p = 0.003, respectively). Additionally, improvements were observed in medical record completeness, supporting examination documentation, and administrative accuracy. A standardized manual administration system effectively decreases pending claims in JKN by improving documentation and claim verification processes. Further research is needed to explore the long-term sustainability of this model and the potential benefits of digitalization.  
Co-Authors Mathar, Irmawati Yeni Utami