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All Journal Media Kesehatan Masyarakat Indonesia Media Penelitian dan Pengembangan Kesehatan Jurnal Kesehatan Reproduksi Jurnal Kesehatan Syntax Literate: Jurnal Ilmiah Indonesia Jurnal Manajemen Kesehatan Yayasan RS.Dr. Soetomo Journal of Health Policy and Management Fair Value: Jurnal Ilmiah Akuntansi dan Keuangan Proceedings of the International Conference on Applied Science and Health Jurnal Ners jurnal syntax admiration Jurnal Manajemen Pendidikan dan Ilmu Sosial (JMPIS) Journal of Economics and Business UBS Jurnal Cahaya Mandalika JOURNAL SCIENTIFIC OF MANDALIKA (JSM) Community Medicine and Education Journal Media Publikasi Promosi Kesehatan Indonesia (MPPKI) COMSERVA: Jurnal Penelitian dan Pengabdian Masyarakat Berita Kedokteran Masyarakat Jurnal Manajemen Pelayanan Kesehatan (The Indonesian Journal of Health Service Management) Eduvest - Journal of Universal Studies Jurnal Ekonomi dan Pembangunan Indonesia Jurnal Ar Ro'is Mandalika (Armada) Journal of Indonesian Health Policy and Administration Jurnal Ekonomi Kesehatan Indonesia Jurnal Ilmu Kesehatan Masyarakat (The Public Health Science Journal) Kesmas: Jurnal Kesehatan Masyarakat Nasional (National Public Health Journal)
Prastuti Soewondo
Departemen Administrasi & Kebijakan Kesehatan, Fakultas Kesehatan Masyarakat, Universitas Indonesia
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Journal : COMSERVA: Jurnal Penelitian dan Pengabdian Masyarakat

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Analisis Klaim Pending BPJS Kesehatan di RSUD Pasar Minggu Tahun 2024 Wirdah, Wirdah; Soewondo, Prastuti; Kartika Dewi, Endah
COMSERVA : Jurnal Penelitian dan Pengabdian Masyarakat Vol. 5 No. 2 (2025): COMSERVA: Jurnal Penelitian dan Pengabdian Masyarakat
Publisher : Publikasi Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.59141/comserva.v5i2.3234

Abstract

Based on the results of the verification of claims at Pasar Minggu Hospital, the number of pending claims at the end of 2024 has increased both in terms of the number of claims and the cost of claims. In hospitals with a JKN service level of > 80%, the occurrence of pending claims can affect the hospital's cash flow. This study aims to analyze data on pending claim cases to be able to map the group of causes of pending cases. The method of writing the article used is a quantitative cross-sectional design, which is an approach based on data collection that can present information in a short time. As a result, the average number of pending cases at Pasar Minggu Hospital is 5.45% of the total number of claim files filed in 2024, while when viewed from the amount of pending claims, it reaches 17.13%. In inpatient services, the percentage of pending claims based on the number of files on average reached 1.02% and 15.48% when viewed from the value of claims. On the other hand, in outpatient services, the average number of claims based on files is higher, which is 4.43% and in terms of claim value, the portion is 1.66%. The cause of pending claims when reviewed from the number of files is the most due to the aspect of administrative completeness, which is 45.07%. Meanwhile, when viewed from the amount of cost or claim value, the group that caused the most pending claims was due to the aspect of coding rules at 44.10%. The factors that cause pending claims at Pasar Minggu Hospital consist of four factors: human (the service team and casemix have varying levels of understanding of coding and medical aspects, money (the budgeting process for updating coding knowledge and skills is not routine), method (the autoclosing system in the outpatient file claim process, in the inpatient claim process, the coding process is carried out at the end of the service), material (PPK updates have not been done regularly, so there are still variations in services), and machines (the coding system in SIMRS is still done with manual input).
Analisis Klaim Pending BPJS Kesehatan di RSUD Pasar Minggu Tahun 2024 Wirdah, Wirdah; Soewondo, Prastuti; Kartika Dewi, Endah
COMSERVA : Jurnal Penelitian dan Pengabdian Masyarakat Vol. 5 No. 2 (2025): COMSERVA: Jurnal Penelitian dan Pengabdian Masyarakat
Publisher : Publikasi Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.59141/comserva.v5i2.3234

Abstract

Based on the results of the verification of claims at Pasar Minggu Hospital, the number of pending claims at the end of 2024 has increased both in terms of the number of claims and the cost of claims. In hospitals with a JKN service level of > 80%, the occurrence of pending claims can affect the hospital's cash flow. This study aims to analyze data on pending claim cases to be able to map the group of causes of pending cases. The method of writing the article used is a quantitative cross-sectional design, which is an approach based on data collection that can present information in a short time. As a result, the average number of pending cases at Pasar Minggu Hospital is 5.45% of the total number of claim files filed in 2024, while when viewed from the amount of pending claims, it reaches 17.13%. In inpatient services, the percentage of pending claims based on the number of files on average reached 1.02% and 15.48% when viewed from the value of claims. On the other hand, in outpatient services, the average number of claims based on files is higher, which is 4.43% and in terms of claim value, the portion is 1.66%. The cause of pending claims when reviewed from the number of files is the most due to the aspect of administrative completeness, which is 45.07%. Meanwhile, when viewed from the amount of cost or claim value, the group that caused the most pending claims was due to the aspect of coding rules at 44.10%. The factors that cause pending claims at Pasar Minggu Hospital consist of four factors: human (the service team and casemix have varying levels of understanding of coding and medical aspects, money (the budgeting process for updating coding knowledge and skills is not routine), method (the autoclosing system in the outpatient file claim process, in the inpatient claim process, the coding process is carried out at the end of the service), material (PPK updates have not been done regularly, so there are still variations in services), and machines (the coding system in SIMRS is still done with manual input).
Co-Authors Ade Widyati Prastyani Amila Megraini Anakito Ekabela Khadijah Andardi, Biancha Anggun Kusumasari, Jorra Putri Ardi Adji, Ardi Astuti, Trihardini Sri rejeki Athiyah Athiyah Athiyah, Athiyah Atik Nurwahyuni Audita, Fatira Ratri Azhar, Rodiyah Aziz, Moch Fathonil Azwar, Nurlie Biancha Andardi Carolinsia, Brenda Dian Kusumawardhani Dian Kusumawardhani Ditia Gilang Shah Putra Rahim Dwi Ayulestari Dwi Oktiana Irawati Emmy Ridhawaty Mangunsong Eureka, Agnes Nina Evelyn Hendarta Farianti, Yuli Farida Kusumaningrum Gilang Shah Putra Rahim, Ditia Halimah Halimah Halimah Halimah Hanis Fuad Hartono Tanto Helena Turnip Helena Turnip Helmi Wahyuningsih Hermansyah, Acep Arief Heydi Marizky Lisman Hidayati, Ira Rahma I Nyoman Gede Semarajana Ida Bagus N Maharjana Indriansyah, Fahlepi Jatnika, Viana Villamanda Johar, Meliyanni Kartika Dewi, Endah Kurnia Sari Kurnia Sari Mahardhika, Jeffrey Christian Mangunsong, Emmy Ridhawaty Mardiati Nadjib Martawinata, Sulaiman Mazda Novi Mukhlisa Megraini, Amila Meliyanni Johar Meliyanni Johar Muhammad Ade Armansyah Siregar Muhammad Hafiz Aini Mukhlisa, Mazda Novi Muliawati, Mutia Mursalin . Mursalin Mursalin Nadjib, Mardiati Novita Dwi Istanti Nur Fatimah Nurlie Azwar Nurul Maretia Rahmayanti Nurwahyuni, Atik Nurwahyuni, Atik Permanasari, Vetty Yulianty Pramanto, Heru Prastyani, Ade Widyati Pujisubekti, Retno Purbasari, Utami Rahmayanti, Nurul Maretia Retno Pujisubekti Retno Pujisubekti Retno Pujisubekti Risa De Apna Roslina, Trias Santoso, Anindita Satrio, Harsa Kunthara Sayekti, Sekar Arum Handarbeni Sekar Arum Handarbeni Sayekti Siregar, Muhammad Ade Armansyah Sugeng Winarno, Sugeng Taufik Dipa Sempana Trihardini Sri Rejeki Astuti Trihardini Srirejeki Astuti Ummu Hani Wahyuningsih, Helmi Wibisono, Iqbal Dawam Wirastuti, Ida Ayu Wirawan, Handi Wirdah, Wirdah Yuli Farianti Yulius, Suci Kirana Yunita Yunita Yunita Yunita Yussi Damayanti Zainal Abidin