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All Journal Jurnal Kesehatan Masyarakat (JKM) CENDEKIA UTAMA Jurnal Kedokteran dan Kesehatan Jurnal SOLMA JITK (Jurnal Ilmu Pengetahuan dan Komputer) Journal of Public Health for Tropical and Coastal Region Jurnal Manajemen Informasi dan Administrasi Kesehatan Journal of Epidemiology and Public Health Jurnal Nasional Pendidikan Teknik Informatika (JANAPATI) JSAI (Journal Scientific and Applied Informatics) Jurnal Abdi Masyarakat (JAM) PREPOTIF : Jurnal Kesehatan Masyarakat Jurnal Ners Jurnal Ilmu Kesehatan Masyarakat Berkala IJECS: Indonesian Journal of Empowerment and Community Services MAHESA : Malahayati Health Student Journal Jurnal Pengabdian Masyarakat (ABDIRA) Sehat Rakyat: Jurnal Kesehatan Masyarakat Journal Research of Social Science, Economics, and Management Pro Health Jurnal Ilmiah Kesehatan Jurnal Pengabdian Masyarakat Nasional Jurnal Kesehatan The Journal of Educational Development International Journal Of Public Health Jurnal Sains dan Kesehatan JCOSIS (Journal Computer Science and Information Systems)
Nur Ani
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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 Aminuddin, Arief Andi Nugroho, Andi Anisa , Nur Anita Ratnasari ARDIANSYAH ARDIANSYAH Arham Hanif Febria Ariansyah Arif Wibawa, Prasetya Arista Ririn Yulianti Asriati, Yul Awusi, Riati Yulia Emanuel Ayudia Johar, Syefira Ayudia, Syefira Ayumi, Vina Aziz, Faisal Bagus Priambodo Bakhtiar, Bakhtiar. Beknazar, Achmad Hait Aliyumni Catra Pratama, Suga Desi Ramayanti Dewi Puspito Sari, Dewi Puspito Djatmiko Hidajat Doni Munggaran, Muhamad Elissa Maharani, Nine Fardiansyah, Dwiki Fiqi Nurbaya Iik Sartika Iik, Sartika Indhun, Qomariah Intan Istiqomah, Intan Irawan, Bibit Julia, Pertiwi Jumaryadi, Yuwan Junaidi Junaidi Junior, Nickolas Kameswara, Gilang Mahesa Khoirunisa, Asahra Kusnendar, Yustinus Krisna Lemi Iryani Lutfiana Kusumawati, Lutfiana Maharani, Nine Elissa Mariana Purba Maulia, Putri Maysyanda, Charista mdf, sulisti Nia Umilizah Noprisson, Handrie Nugraho, Farid Setyo Nugroho, Farid Setyo Nur Ismawati, Nur Paskanita, Maria Paulitan, Alsih Priskila Gani Puji Hastuti Purba, Mariana Puspito Sari, Dewi Putra, Erwin Dwika Rahardjo, Budhi Rinto Priambodo Rosyidah, Marlia Yulianti Salsabila, Naj'wa Sari, Noviana Ristika Sartika , Iik Sarwati Rahayu Sholihah, Imrok Atus Siti Maesaroh Susanti, Ika Yani Susi Purnama Afrilia Syamsiar, Syamsiar Syefira Ayudia Johar Titik Haryanti Titik, Haryanti Trapsilo, Firdaus Yuli Ulfah, Hana Rosian Utami, Amrih Gancar Wachyu Hari Haji Wachyu Hari Haji Wartini Wartini Wartini Wartini Wartini, Wartini Wuryandari, Wuryandari Yosephine Sinaga, Desi