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All Journal Maksimum : Media Akuntansi Universitas Muhammadiyah Semarang Media Kesehatan Masyarakat Indonesia Health Science Journal of Indonesia Jurnal Kebijakan Kesehatan Indonesia ADVANCE Jurnal Kedokteran dan Kesehatan : Publikasi Ilmiah Fakultas Kedokteran Universitas Sriwijaya Jurnal Online Mahasiswa (JOM) Bidang Keguruan dan Ilmu Pendidikan Jurnal Kesehatan Masyarakat (JKM) CENDEKIA UTAMA PENELITIAN DAN KARYA ILMIAH Syntax Literate: Jurnal Ilmiah Indonesia PENTAS : Pendidikan Bahasa dan Sastra Indonesia Jurnal Organisasi Dan Manajemen Media Kesehatan Politeknik Kesehatan Makassar Jurnal Ilmu Kesehatan Masyarakat (The Public Health Science Journal) Proceedings of the International Conference on Applied Science and Health Journals of Ners Community Jurnal Keperawatan Respati Yogyakarta Media Karya Kesehatan Magisma: Jurnal Ilmiah Ekonomi dan Bisnis J-Kesmas: Jurnal Kesehatan Masyarakat (Indonesian Journal of Public Health) Grouper: Jurnal Ilmiah Perikanan Jurnal Medika Hutama Jurnal Inovasi Penelitian Jurnal Sibernetika Jurnal Kesehatan Tambusai AN-Nur: Jurnal Kajian dan Pengembangan Kesehatan Masyarakat Jurnal Riset Manajemen dan Bisnis Jurnal Teknologi Kesehatan Journal of Islamic Economics and Finance Jurnal Jaminan Kesehatan Nasional PEKBIS Berita Kedokteran Masyarakat Jurnal Penelitian dan Karya Ilmiah Lembaga Penelitian Universitas Trisakti Journal of Islamic Economics and Finance Neurona Jurnal ARSI : Administrasi Rumah Sakit Indonesia Journal of Indonesian Health Policy and Administration Equilibrium Point : Jurnal Manajemen Bisnis Jurnal Ekonomi Kesehatan Indonesia
Nurwahyuni, Atik
Departemen Administrasi Dan Kebijakan Kesehatan, Fakultas Kesehatan Masyarakat, Universitas Indonesia
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Analisis Klaim Rawat Inap RSUD Kebayoran Baru November 2022 – April 2023: Pendekatan Sistem Rabiulyati, May; Nurwahyuni, Atik; Pujiyanto, Pujiyanto
Jurnal Ekonomi Kesehatan Indonesia Vol. 9, No. 1
Publisher : UI Scholars Hub

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Abstract

Hospitals receive payments through claim submissions with complete documents to the Social Security Administering Agency (BPJS) Health. However, not all inpatient claims have been submitted to BPJS Health, and there are still 16.97% pending inpatient claims. In claims that are not approved, claims can be resubmitted, but time constraints for the claim process have resulted in 2.64% of inpatient cases in 2022 not resubmitted. Qualitative research through in-depth interviews with 15 respondents aims to analyze the management of inpatient claims for BPJS Kesehatan Kebayoran Baru Hospital from November 2022 to April 2023. The study results showed that not all printed Participant Eligibility Letters (SEP) have been submitted for inpatient claims. There were 10.97% pending claims, with the cause being incomplete doctor's medical resumes for 59 inpatient files (32.2%) and inconsistencies in submitting claim files for 81 inpatient files (44.3%). This is due to the suboptimal feedback and monitoring, so it is necessary to establish a claim management monitoring flow. Hospitals must also establish Standard Operating Procedures (SOP) for integrated claim management. This study is expected to be a strategic guide to improve BPJS Kesehatan claim management with Focus Group Discussion (FGD) efforts for collaboration between agencies/units/teams and better cooperation between hospitals and BPJS Kesehatan. All solutions implemented are expected to improve the quality of hospital claims.
Inpatient Readmission Insidence of National Health Insurance Patients at Partner Hospitals of BPJS-Health in Sukabumi 2015 Atmiroseva, Atmiroseva; Nurwahyuni, Atik
Journal of Indonesian Health Policy and Administration Vol. 2, No. 2
Publisher : UI Scholars Hub

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The INA-CBG payment system in the JKN program allegedly increasing the incidence of readmission. This study aims to map the incidence of readmission in JKN participants admitted to thirteen partner hospitals of BPJS-Health in Sukabumi. The research design is a descriptive study with the unit of analysis is patient. The study used secondary data from inpatient claims in thirteen partner hospitals BPJS-Health Sukabumi which has been verified during 2015. The study found that the number of readmission is 8.81% with the most readmission incidence occurs in the equal CMG category and at the least in the equal severity level category. The cost of inpatient readmission services is more expensive 104-113% of the initial care cost. Moreover, about 15- 16% cases of severity level readmission is increasing and 12-13% of its severity level is decreased. Less than 3% cases of readmission ended not good because they died, were referred, or had to come home forcibly.
Policy Content Analysis in Minister of Health Regulation Number 15 of 2016 about Hajj Health Istithaah Idris, Salman Mauluddin; Nurwahyuni, Atik
Journal of Indonesian Health Policy and Administration Vol. 9, No. 2
Publisher : UI Scholars Hub

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Abstract

Indonesia has the world's largest Muslim population and sends the most pilgrims to Saudi Arabia. The Hajj Health Istithaah Policy in Minister of Health Regulation Number 15 of 2016 is the government's effort to carry out health screening for pilgrims before leaving so that they can perform the Hajj in a healthy and independent condition. This research was conducted using a qualitative approach by collecting data through in-depth interviews and document reviews. In this study, Walt and Gilson's Policy Triangle Model was used as a reference for reviewing the Hajj health istithaah policy, especially in the content section of the document and its implementation. The aspects reviewed are the harmonization and relevance of policy content and implementing regulations for the Hajj pilgrimage. Monitoring and evaluation are carried out to monitor the progress and development of policies. Revisions and simplifications of the substance of the policy based on the results of discussions and suggestions from stakeholders are used as input to make improvements to the content of the Hajj health istithaah policy. The conclusion of the review results shows that the policy has been implemented correctly from the center to the regions; research recommendations need revision and simplification of the substance of the Hajj Health Istithaah Policy, as well as other efforts so that pilgrims can achieve health istithaah conditions before leaving to perform the pilgrimage in Saudi Arabia.
Analisis Klaim Pending, Verifikasi dan Audit Pascaklaim Jaminan Kesehatan Nasional Ulil Amri, Anugrah Aulia; Nurwahyuni, Atik
Jurnal Ekonomi Kesehatan Indonesia Vol. 9, No. 2
Publisher : UI Scholars Hub

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Abstract

The implementation of Indonesia’s National Health Insurance (JKN) poses new challenges for hospitals as service providers. Badan Penyelenggara Jaminan Sosial (BPJS) Kesehatan, the program’s administrator, now routinely conducts post-claim verifications and audits after claims have been paid. This often results in claim adjustments or even full reversals of previously reimbursed amounts. This case study examines JKN claim management at a Type D General Hospital in 2022, focusing on pending claims, verification, and post-claim audits, using a systems theory framework. Key issues in pending claims include incomplete medical records (29%), insufficient supporting documents (24%), and coding errors (21%). Post-claim problems primarily stem from problematic service episodes (39%), coding errors (31%), and incomplete medical records (22%). These challenges arise from systemic issues in the hospital's JKN claim management, necessitating improvement. Recommendations emphasize internal hospital reforms, including enhanced training programs, improved communication with leaders, accurate ICD-based diagnoses and procedures, redesigned medical record formats, and the development of electronic medical records. The study also suggests appointing functional medical staff, training for Medical Committee Chairs, and advocating for budget allocation. Furthermore, the study recommends that the Health Office improve inter-agency coordination and provide constructive input to the government regarding BPJS Kesehatan’s post-claim audit practices, which often deviate from regulations. Enhancing the BPJS Kesehatan application is also necessary to establish a more effective feedback mechanism for addressing JKN claim issues.
Technology Acceptance Model Toward Pandawa Service at the Social Security Administrative Body for Health Depok Yoam, Crefinda Hanna Ananda; Pujiyanto; Atik Nurwahyuni; Damaryanti, Laksmi
Jurnal Jaminan Kesehatan Nasional Vol. 5 No. 2 (2025): Jurnal Jaminan Kesehatan Nasional
Publisher : BPJS Kesehatan

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.53756/jjkn.v5i2.367

Abstract

Digital transformation has become a prominent topic in the era of globalization. Despite the growing digital transformation trend, many health service users in Indonesia still prefer face-to-face interactions, indicating a gap in digital literacy and service adoption. In response to this issue, the Social Security Administrative Body for Health launched a digital administrative service called Pandawa (Administrative Service via WhatsApp). This study aims to explore the perceptions of National Health Insurance participants who visited Social Security Administrative Body for Health Depok in 2025, focusing on the perceived ease of use and usefulness of the Pandawa service. The research employs a quantitative approach using the Technology Acceptance Model (TAM) through a cross-sectional study design. The secondary data used in this study consists of participant visits to the agency in 2024. Primary data will also be needed through distributed questionnaires. The sample consists of 109 National Health Insurance participants who are users of the Pandawa service and visited the agency during the study, conducted in February 2025. The analysis techniques of the research used the Chi-Square Test and the Binary Logistic Regression Test. The multivariate analysis shows that age, education, perceived ease of use, perceived usefulness, and attitude are significantly related to the intention to use the Pandawa service, with attitude being the dominant factor. Meanwhile, sex does not show a significant relationship to the intention to use the Pandawa service. Overall, user acceptance of the Pandawa service is relatively good, although further improvements in service quality are necessary to optimize its implementation.
Hubungan Kinerja Keuangan Dan Kinerja Pelayanan Terhadap Tingkat Maturitas BLU Pada Poltekkes Kemenkes Tahun 2022 - 2023 Rybob Khomes; Atik Nurwahyuni
Jurnal Teknologi Kesehatan (Journal of Health Technology) Vol. 21 No. 2 (2025): September 2025
Publisher : POLTEKKES KEMENKES YOGYAKARTA

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.29238/jtk.v21i2.2876

Abstract

Penelitian ini menganalisis hubungan kinerja keuangan dan kinerja pelayanan pada IKU terhadap tingkat maturitas BLU pada Poltekkes Kemenkes. Dengan latar belakang bahwa capaian IKU yang relatif baik, belum berbanding lurus dengan tingkat maturitas BLU, diharapkan penelitian ini dapat memberi rekomendasi perbaikan IKU agar menunjang maturitas BLU. Penelitian dilakukan di lingkungan Direktorat Jenderal Sumber Daya Manusia Kesehatan Kementerian Kesehatan pada bulan Januari – Juni 2025. Studi ini menggunakan desain observasional cross sectional dengan pendekatan kuantitatif, menggunakan data capaian IKU dan tingkat maturitas BLU dari 18 Poltekkes Kemenkes yang sudah berstatus BLU pada tahun 2022 – 2023, dengan total 36 observasi. Hasil analisis menunjukkan bahwa dari 12 indikator yang diuji, hanya dua indikator yang berhubungan signifikan secara statistik terhadap tingkat maturitas BLU, yaitu persentase realisasi pendapatan BLU terhadap beban operasional pada kinerja keuangan dan kualitas kelembagaan pada kinerja pelayanan. Oleh karena itu, penelitian ini merekomendasikan perbaikan indikator IKU agar benar – benar menunjang maturitas BLU Poltekkes Kemenkes.
Co-Authors ', Gusnardi ', Sumarno Adang Bachtiar Adik Wibowo Ahmad Sulaiman Alwahdy Alexsander Putra Ambarita, Anna Tirawani Andre Yunianto Anis Sakinah Utami Anna Tirawani Ambarita Annathasia Annathasia Asri Hikmatuz Zahroh Athiyah, Athiyah Atmiroseva, Atmiroseva Ayu Novia Kurnia Ayunda Oktavia Bagas Yushila Tamami Rizqo Baros, Wan Aisyiah Benjamin Saut Budi Safari Cicih Opitasari Citra Jaya Cyntiya Rahmawati Cyntiya Rahmawati Daeli, Widi Astutty Casimira Damaryanti, Laksmi Damayan, Anak Agung Istri Agung Sri Stuti Daruki, Maria Wahyu Dedy Revelino Diah Fitri Novita Sari Diah Melly Marlyana Dian Agnesa Sembiring Dian Elawati Dibyo Iskandar Dilla Syamola Dini Karwati Djoko M Hartono Donny Hamid Dwi Budi Prastiani Endah Sih Prihatini Erdayani Erdayani Ery setiawan Ery Setiawan Setiawan Erzan Dhanalvin Estherlina Sitorus Euis Nurjannah Evie Ni'matunnisa Fachmi Idris Fadliyah, Hilyatul Fadllil Kaafi Fahminur ' Faisol Mas’ud Faisol Masud Farianti, Yuli Febriadi, Yudi Felicitas Nia Aryani Firda Jusela Fitri Octaviana Fredinan Yulianda Fuquh Rahmat Shaleh Gani Haryana Garaika Genoveva Maditias Dwi Pertiwi Gimin Gimin Giusman, Reli Gusnardi ' Hilyatul Fadliyah Ida Bagus N Maharjana Idris, Salman Mauluddin Ika Purnamasari Jawanri Citra PS Kurnia Sari Kurnia, Ayu Novia Latanza Shima Lestari, Erna Madya, Sri Denti On Mangunsong, Emmy Ridhawaty Marshia Rehatalanit Megraini, Amila Mirza Aulia Moch Saad Muhammad Lian Kautsar Mukhlisa, Mazda Novi Mukti Ali Mundiharno Mundiharno Nadjib, Mardiati Natalia Melani Nia Priyatiningsih Nurhabibah Nurhabibah Pantri Widyastuti Pantri Widyastuti Pradya Rafthudyanti Prastuti Soewondo Pujiyanto Pujiyanto Pujiyanto Pulungan, Nopiana Pusposari Purwoko Rabiulyati, May Rasinta Ria Ginting Rejeki, Vera Marietha Meinar Reli Giusman Renindra Ananda Aman Rina Selva Johan Rira Martaliza Rizki Asriani Putri Rudi Suryo Kristanto Rybob Khomes Sakdanur Nas Salman Mauluddin Idris Sayekti, Sekar Arum Handarbeni Sembiring, Dian Agnesa setyo Pantawis Simbolon, Joni Pranata Sri Denti On Madya Sri Denti On Madya Suarman ' Suci Atiningsih Suherman, Suherman Suwedia, I Nyoman Gede Bayu Wiratama Tetriadi Tetri Tetriadi Tetriadi, Tetriadi Tetriyadi, Tetriyadi Tiara Aninditha Tiara Aninditha Tri Priyo Anggoro Tri Priyo Anggoro Vera Marietha Meinar Rejeki Wahyudi, Chandra Tri Wahyuni, Asri Nur Wahyuningsih, Helmi Wan Aisyiah Baros Widi Astutty Casimira Daeli Widi Astutty Casimira Daeli Widyastuti, Pantri Widyatutti Widyatuti Yenni Khristiana Yesi Astri Yoam, Crefinda Hanna Ananda Yohanes Fery Cahaya Yuliani Yuliani Yunavita Uzzie Elsanti Yunita Yunita Zahrul Arief Intasar