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All Journal Jurnal Simantec Jurnal Kesehatan Hesti Wira Sakti Multidiciplinary Journal Jurnal Manajemen Informasi dan Administrasi Kesehatan JURNAL PENDIDIKAN TAMBUSAI Hearty : Jurnal Kesehatan Masyarakat Jurnal Manajemen Informasi Kesehatan Indonesia (JMIKI) Indonesian of Health Information Management Journal (INOHIM) Jurnal Ilmiah Permas: Jurnal Ilmiah STIKES Kendal KESMAS UWIGAMA: Jurnal Kesehatan Masyarakat Jurnal Peduli Masyarakat jurnal syntax admiration Budapest International Research and Critics Institute-Journal (BIRCI-Journal): Humanities and Social Sciences Jurnal Teknik Informatika (JUTIF) Jurnal Kesehatan Tambusai J-REMI : Jurnal Rekam Medik dan Informasi Kesehatan PELS (Procedia of Engineering and Life Science) Journal of Training and Community Service Adpertisi Jurnal Kesehatan Amanah Jotika Journal in Management and Entrepreneurship Promotor: Jurnal Mahasiswa Kesehatan Masyarakat Jurnal manajemen informasi kesehatan Journal of International Multidisciplinary Research ASSYIFA: Jurnal Ilmu Kesehatan Jurnal ARSI : Administrasi Rumah Sakit Indonesia Proceeding International Conference Of Innovation Science, Technology, Education, Children And Health Ulil Albab Jurnal Rekam Medis dan Informasi Kesehatan Indonesia Proceeding International Conference Of Innovation Science, Technology, Education, Children And Health
ACHMAD JAELANI RUSDI
Institut Teknologi, Sains Dan Kesehatan RS Dr. Soepraoen Malang, Indonesia
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Journal : jurnal syntax admiration

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Determinan Pending Claim Badan Penyelenggara Jaminan Sosial Kesehatan di Rumah Sakit Nayada Ilfania Arokhta Yunifa; Achmad Jaelani Rusdi; Lilik Afifah
Jurnal Syntax Admiration Vol. 6 No. 1 (2025): Jurnal Syntax Admiration
Publisher : Syntax Corporation Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.46799/jsa.v6i1.2092

Abstract

Pending claims are a problem that still often occurs in Indonesia, where many hospitals face obstacles in the BPJS Kesehatan claim process. This problem can have a significant impact on the quality of health services. This study aims to analyze the factors that cause BPJS Kesehatan pending claims in hospitals. The method used is literature review by searching for articles through the Google Scholar database in the last five years. The study follows PRISMA guidelines and uses the PICO framework to determine inclusion and exclusion criteria. The keywords used in the search involve the operator's boolean: "Factor" AND "Pending Claim" OR "Return" AND "BPJS" OR "JKN". From the search results, 20 articles were found that were worthy of systematic review. The results of the review showed that 17 articles identified internal factors as the main cause of pending claims, especially the incompleteness of supporting documents such as laboratory results, ECG, and chronological letters. In addition, 19 articles revealed external factors as the main cause, namely lack of thoroughness and responsibility in carrying out tasks, such as data input errors, incompleteness in filling out medical resumes, and inaccuracies in diagnostic or action codes. Internal and external factors influence each other, so the right solutions are needed for every aspect, including improving the quality of documentation, improving the e-claim information system, and developing human resource competencies through training.
Co-Authors Abdur Rauf, Abdur Agung, Arnoldus Anugerah Agustina Rusfadir Akbar, Prima Soultoni Amalia Nur Kamila Amellia, Elsa Andara Dita Amellia Ana Fitriani Ancah Caesarina Novi Marchianti Anggraini, Retno Dwi Anis Ansyori Annastasia, Shinta Aprilia, Sendi Fantrri Arimbi Ulfa Nazira Aris Setyawan Ayu Indah Oktavia Ayu Indah Oktavia Ayuni, Amelia Septi Bulgis, Malikal Caesar Putra, Muhammad Dudayev Choiriyah, Ana Cininta, Sabila Nada Ayunani Diva Nur Asmianova Eka Agustina, Eka Faid, Roifatul Farma Duana Febrisari Putri Febrisari Putri Ramadani Fita Rusdian Ikawati Fita Rusdian Ikawati Fitriyani, Endang Hammam Abror Asminoto Ikawati, Fita Rusdian Jannah, syahfira nur jannah Khofiza Ardhani Ali Raharusun Khuriyana Patty Kirana, Erinia Rahayu Okta Kurniawan, Fendi Kusumaningrum, Tyas Lilik Afifah Lilik Afifah M. Yogi Riyantama Isjoni Ma'roef, Moch. Noer Hoedan Ma'ruf, Agus Sukron Maharani, Devi Maharani, Happy Eprilia Mahyuni, Ni Putu Reni Margareta, Ananda Agustin Marselina, Elystia Vidia Mawadda, Widdy Ma’ruf, Agus Syukron Melody Muna Anggraeni Moch.Noer Hoedan Ma’roef Moch.Noer Hoedan Ma’roef Mochamad Anshori Muslim, Saepul Nabila, Assiva Putri Nadhya Arie Twungga Dewi Murcahayaning Wulan Nayada Ilfania Arokhta Yunifa Nazira, Arimbi Ulfa Ni Putu Reni Mahyuni Ninda, Rahmaninda Putri Gading Ningsih, Dovi Dwi Mardiyah Nugraheni, Shevia Dwi Nuril Khabibatul Jamilah Oktariyono, Wisnu Rafi Oktoriani, Ervita Nindy Prabowo, Rahmadyo Yudhi Putri, Alya Nurryta Putri, Fenanda Berliana Putri Putri, Meuthia Berliana Qodar, Mita Lailatul R. A. Rengganis Ularan R.A. Rengganis Ularan Raharusun, Khofiza Ardhani Ali Rahma Putri Kasimbara Rengganis Ularan Retno Dewi Prisusanti Rifqi, Amir Muhammad Rizka Andika Sari Rusfadir, Agustina Sabila Nada Ayunani Cininta salsabila, Tsabita Amadea Sangkot, Hartaty Sarma Santy Irene Putri Saputri, Giovany Okvia Septya Anggari Salsa Hari Sukma Shoim, Achmad Slamet Suhariyono, Untung Slamet, Untung Suhairi, Ariski Yantika Suhariyono, Untung Slamet SUWITO SUWITO Syahira, Nurfathina Trisnanto, Puguh Yudho Umar Yasin, rana zakaria Untung Slamet Untung Slamet Suhariyono Untung Slamet Suhariyono Veninda, Nabella Wahandika, Akbar Novando Putra Widasari, Immaculata Vettha Sarasvati Y A Triana Ohoiwutun Yosin, Kresensia Dasilva Zein, Eiska Rohmania