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Maya Kasmita
Universitas Negeri Makassar
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Analysis of Disparities in INA-CBGs Claim Verification Turnaround Time: A Case Study in Type C and B Regional Government-Owned Hospitals Maya Kasmita; Sulaiman Putra Nagaring
Journal of Health Service Administration and Hospital Management Vol. 1 No. 1 (2025): January, 2025
Publisher : CV. Get Press Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.69855/jhsah.v1i1.368

Abstract

This study investigates disparities in the Turnaround Time (TAT) for INA-CBGs claim verification between Type B and Type C Regional Public Hospitals (RSUDs) under the National Health Insurance Program (JKN). Although the regulatory TAT standard is 15 days, verification time often deviates, impacting hospital liquidity. The research quantifies the influence of Hospital Type on TAT, controlling for Case Mix Index (CMI) (Type B CMI ≈ 1.75 vs. Type C ≈ 1.25) and Pending Claim Ratio (Type C ≈ 12.5% vs. Type B ≈ 8.5%). Employing a quantitative comparative design on secondary data from 50 RSUDs (20 Type B, 30 Type C) (2021–2024), results confirm a statistically significant disparity. Type B RSUDs achieved a mean TAT of 14.2 days (near standard), significantly shorter than Type C RSUDs at 17.8 days (exceeding standard). Multivariate analysis showed that hospital type is a strong negative predictor of TAT, suggesting administrative resources and process maturity outweigh case complexity. Policy implications emphasize the need for targeted capacity-building and improving the coder-to-bed ratio in Type C RSUDs and utilizing Type B hospitals for benchmarking best practices to optimize JKN efficiency and financial sustainability.
Co-Authors A, M Awaluddin Abdul Rahman Aditya Wardhana Afriyanti, Riska Afwa Magfhirah Saleh Ahmad Syarief Iskandar Aina, Asri Nur Aliah, Nurul Amalia Putri Amelia, Putri Andi Aslinda Andi Caesar To Taddampali Andi Cudai Nur Andi Dewa Mauraga Andi Dewi Riang Tati Andi Fachruddin Andi Muhammad Rivai Arief Ramadhan Aris Baharuddin Aris Baharuddin Aris Baharuddin Armansyah, Budi Ashari Ismail Aslinda Aslinda Aslinda Aslinda, Andi Aslinda, Aslinda Asmar Asmar, Asmar Asmaul Husnah Nasrullah Asmunandar Asmunandar Aulia, Aulia Bahar, Sarah Bahri bahri Bakhtiar, Bakhtiar. Bustomi, Thomas dahyar daraba, dahyar Darman Manda Manda Dodi Ilham Dyan Darmayanti Darmayanti Elwardah, Khairiah Faizah Khaeruddin Farida Akbarina Fatimah Akbal Firman Umar FIRMAN UMAR Firman, M. Jihad Fitriandini Fitriandini Fitriani Dzulfadhilah Haedar Akib Hanisa, Nur Henni Zainal Henri Henri, Henri HERI TAHIR HERI, RIRIN NURFAATHIRANY Imran, Siti Nurfadila Insani, Al Fajrin Irensi Seppa, Yusi Izzati Qur'aini, Dzul Jamaluddin Jamaluddin Jihad Firman, Muhammad Jumadi Jumadi Junaeda, St Junaeda, St. Khaeruddin, Faizah Mendrofa, Syah Abadi Misna Muh Luthfi Siraj Muh. Darwis Muh. Rizal Muh. Rizal Muhammad Aswan Muhammad Guntur Muhammad Jihad Firman Muhammad Jihad Firman Muhammad Jihad Firman Muhammad Luthfi Muhammad Luthfi Siraj Muhammad Luthfi Siraj Muhammad Luthfi Siraj Muhammad Rizal Namira Ummi Khalsum Nengsi Agustianti Nur Yamin, Muh Nurfaathirany, Ririn Nurhasni Muis Nurhasnni Muis Nurhidayah Nurhidayah Nurul Aliah Nurul Aswar Paramitha, Dyan R, Nurazizah Rahmi Rachmatan, Rachmatan Rahmawati, Nosita Ridhawati, Ridhawati Rifdan . Rina Pati RIRIN NURFAATHIRANY HERI Ririn Nurfaathirany Hery Ririn Nurfaatirany Heri Risma Niswaty Rivai, Andi Muhammad Rizal S, Muh. Rohmah Rifani RR. Ella Evrita Hestiandari Rudi Salam Ruslaily Ramadhana S, Muh. Rizal Sadewi, Juwita Putri Sakawati, Herlina Saputra, Fery Ikhsan Savira, Reza Seppa, Yusi Irensi Sirajuddin Saleh Siti Helmyati Siti Syarifah Wafiqah Wardah Siti Syarifah Wafiqah Wardah Sopia Rukmana, Novayanti St Junaeda St. Junaeda St. Junaeda St. Junaeda Sulaiman Putra Nagaring Sulmiah Sultan, Sulhani Purwanti Suparman Mekka Suradi Tahmir, Suradi Surianti Surianti Susandi, Deny Gunawan Suyuti, Muh. Rizal Suyuti, Rizal Syarifuddin Syarifuddin Tadampali, Andi Caesar to Tadampali, Andi Caezar To Tahir, Hery Tenriulan, Andi Torro, Supriadi Ulfa Dwi Batari Wafiqah, Sitti Syarifah Wahyudi Gani, Andika Wardah, Siti Syarifah Wafiqah Wiwi Indah Sari Wiwik Handayani Yuni, Neneng Patri Yusi Irensi Seppa Yusi Irensi Seppa