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All Journal Majalah Ilmiah Warta Dharmawangsa TIN: TERAPAN INFORMATIKA NUSANTARA PRIMA : Portal Riset dan Inovasi Pengabdian Masyarakat PHARMACOLOGY, MEDICAL REPORTS, ORTHOPEDIC, AND ILLNESS DETAILS (COMORBID) Jurnal Ilmiah Kesehatan Masyarakat Jurnal Manajemen Sistem Informasi Jurnal Manajemen, Ekonomi, Hukum, Kewirausahaan, Kesehatan, Pendidikan dan Informatika (MANEKIN) BULLET : Jurnal Multidisiplin Ilmu AMMA : Jurnal Pengabdian Masyarakat Jurnal manajemen informasi kesehatan Awal Bros Journal of Community Development Jurnal Bisnis dan Pemasaran Digital
Desfa Anisa
Universitas Awal Bros
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Analisis Penyebab Pending Klaim Berkas BPJS Kesehatan Pelayanan Pasien Rawat Inap Di Rumah Sakit X Larasty, Gevi; Farhansyah, Fani; Anisa, Desfa
Jurnal Manajemen, Ekonomi, Hukum, Kewirausahaan, Kesehatan, Pendidikan dan Informatika Vol 2 No 2 : Desember (2023): Jurnal Manajemen, Ekonomi, Hukum, Kewirausahaan, Kesehatan, Pendidikan
Publisher : Shofanah Media Berkah

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Abstract

BPJS Health claim files for Quarter 1 January, February and March 2023 with 129 BPJS health claim files for the most important inpatient services. The reason for the return was because it did not pass the service administration verification, the difference in diagnosis coding between the BPJS coder and the hospital diagnosis code and the incompleteness of the claim file. So the settlement of claims results in pending claims which disrupt the hospital's financial flow. The aim of this research is to find out the most important BPJS Health file claims for inpatient services at Hospital The results of this research are the percentage of factors causing pending BPJS health claims for inpatient services based on the suitability of membership administration, namely 100%. The percentage of factors causing pending BPJS health claims for inpatient services based on suitability of service administration is 91.6% appropriate and 8.4% inappropriate. And the percentage of factors that cause pending BPJS health claims for inpatient services based on suitability of health administration is 94.7% appropriate and 5.3% inappropriate.
Co-Authors Altesa Putri, Delia claudia, claudia Dimas Handika Fani Farhansyah Fani Farhansyah Fani Farhansyah Hasanah, Sinta Niswatun Kusumo, Retno Larasty, Gevi Mirawati, Dian Mulyana Nabila Franciska, Chika Nafisa, Frasya Amanda Natasha Ningrum, Widya Septya Nurwana, Mulia Putri, Widya Retno Kusumo RR. Ella Evrita Hestiandari Safitri, Nur Indah Sarjono Sarjono, Sarjono siti wulandari Tampubolon, Cyntia Widya Putri