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Journal : Jurnal Mantik

Problematic BPJS health patient pending claims in the implementation of INA-CBGS and management handling Sulastri Sulastri; Menap Menap; Sastrawan Sastrawan
Jurnal Mantik Vol. 7 No. 3 (2023): November: Manajemen, Teknologi Informatika dan Komunikasi (Mantik)
Publisher : Institute of Computer Science (IOCS)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35335/mantik.v7i3.4278

Abstract

Guarantee program health (BPJS Health ) does payment to facility health reference level continued (FKRTL) in Indonesian Case Base Groups (INA-CBGs). BPJS health claim is submission cost maintenance patient participant guarantee health national (JKN) by parties House Sick to BPJS health carried out _ in a way collective and billable every the month . Currently _ Still happen problem between BPJS Health and Advanced Level Referral Health Facilities (FKRTL) including the relevant Bima City Hospital with problem coding that doesn't appropriate , medical resumes are not complete , incomplete relevant between medical resumes with results inspection support medical , and errors entry claim . Research objectives This is For know in a way deep regarding : (1) System planning management claim ; (2) System organizing ; (3) Implementation management record medical and files condition claim ; (4) System supervision in management JKN claim . Study This use approach studies case . Research results : (1) SPM recording has not been implemented medical ; (2) The hospital's internal coders and verifiers are not yet available equipped knowledge knowledge INA-CBGs coding , internal verification still underway done manually because _ Not yet There is application internal verification ; (3) Implementation management record medical and files condition claim Not yet in accordance with PMK number 26 of 2021 and BA agreement together guide management solution problem INA-CBGs claims in 2020; (4) System supervision in management JKN claim yet held optimally.
Co-Authors Abda Abda Abdul Haris Abdul Khalik Abdul Khaliq Abdul Muin Abdurrahman Abdurrahman Agus Supinganto Amir Amir Amir Amir Aniharyati, Aniharyati Arip Usman AS, Iwan Kusmayadi Asmadi, Andi Baehaqi Baiq Hikma Rahmatien Baiq Maryam Bakir, Bakir Bayani, Faizul Budiman Budiman Bustanul Atfal D Mustamu Kamal Pa'ni Deby Ayu Alandari Eni Andriani Fitra Arsy Nur Cory'ah Fitra Arsy Nur Cory'ah Fitria Hidayati, Fitria Fitriana, Huniza Harmaen Harmaen Hartati, Budi Haryandi, Halid Hayun, Rambu Af’Idatussolihah Imtihani, Nila Karjono M, Karjono Khalik, Khalik Kusmayadi AS, Iwan Lalu Abdul Khalik Lalu Abdul Khalik Lalu Abdul Khalik Lalu Hersika Asmawariza Lalu Jupriadi Lalu Muhammad Sadam Husen Lalu Sulaiman Lalu Sulaiman Lalu Sulaiman Lalu, Sulaiman Lia Arian Apriani Made Mahaguna Putra Maryam, Baiq Moh Ali Muh Sapi'i Muhammad Luthfi Mursaka Musawirin, Musawirin Musparlin Halid Nova Budiharjo Nurhayati Nurhayati Ovie Lestya Nurdiana Parindra, I Ketut Pratiwi, Dita Retno Pratiwi, Intan Gumilang Prayogi, Saiful Purmafitriah, En Rasyid, Muh. Emilia Sa’di Reza Indra Wiguna Rizal Pratama Adi Putra Saimi Saimi Saimi Saimi Saimi Saimi, Saimi Sapi'i, Muh Sastrawan Sastrawan Sastrawan Sastrawan Sastrawan, Sastrawan Setiawan, Sabar Sismulyanto Srigede, Lalu Wirawan Suardi Suardi Sulaiman, Lalu Sulastri Sulastri Sulwiyatul K Sani Suswinda Yuli Sutomo Swandayana, Putu Gede Wawan Taufandas, Maruli Triyono, Wahyu Wirawan Uswatun Hasanah Wahyu Wirawan Triyono Wahyu Wirawan Triyono Yuni Widyastuti