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All Journal Jurnal Jaminan Kesehatan Nasional
Muhayyina Wahidah
08114132216
Decision Sciences, Operations Research & Management Dentistry Health Professions Medicine & Pharmacology Public Health

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A Efektivitas Peran dan Fungsi Tim Kendali Mutu Kendali Biaya (TKMKB) Provinsi Sulawesi Selatan Dalam Memberikan Rekomendasi Penyelesaian Dispute Klaim Tahun 2021: Efektivitas Peran dan Fungsi TKMKB Dalam Memberikan Rekomendasi Penyelesaian Dispute Klaom FKRTL Muhayyina Wahidah; Irawan Yusuf
Jurnal Jaminan Kesehatan Nasional Vol. 2 No. 2 (2022): Jurnal Jaminan Kesehatan Nasional
Publisher : BPJS Kesehatan

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.53756/jjkn.v2i2.78

Abstract

This study aims to assess the effectiveness of the role and function of the South Sulawesi Province Quality and Cost Control Team in providing recommendations for the settlement of disputed claims. The method used is descriptive quantitative by comparing the claim dispute data in the Month of Loading from January to December 2021 in South Sulawesi Province. The data sources used are from the Monthly Routine Reports of Claims for Branch Office disputes as well as data on increasing claim maturity. The results of the study found that there was a decrease in dispute claim cases after the Quality and Cost Control Team Meeting in 6 Branch Offices and an increase in the quality of the maturity of advanced outpatient and advanced hospitalization claims, so that the role and function of Quality and Cost Control Team in providing recommendations for dispute resolution claims to Social Security Agency of Health and hospital was considered effective.
Efektivitas Implementasi Monitoring Intensif Pemanfaatan Antrean Online melalui Mobile JKN di Fasilitas Kesehatan Rujukan Tingkat Lanjutan (FKRTL) Champion Kantor Cabang Bulukumba Tahun 2022. Muhayyina Wahidah; Andi Rismaniswati Syaiful; Rini Oktaviani Najib; ihwan Prasetiya; Andi Syamsul Bakhri; Andi Rifka Yuliana Sari; Lily Alfy Sahraini; Muhammad Fiqri Adim; Muhammad Rezki; I Gede Bayu Edwin Jenuar
Jurnal Jaminan Kesehatan Nasional Vol. 3 No. 1 (2023): Jurnal Jaminan Kesehatan Nasional
Publisher : BPJS Kesehatan

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.53756/jjkn.v3i1.140

Abstract

This study aims to assess the effectiveness of the implementation of intensive monitoring of the achievements of online queuing system utilization through Mobile JKN for FKRTL Champion in 2022. The method used is descriptive quantitative by comparing data on online queue utilization, quality rate (QR), and the average total service time for outpatient visits through Mobile JKN before and after the implementation of monitoring and piloting of 3 (three) FKRTL Champions in Bulukumba District, Bantaeng Regency, and Jeneponto Regency in 2022 which were chosen to represent each type and class of FKRTL. The results of the study found that the implementation of intensive monitoring and the piloting of 3 FKRTL Champions which had been carried out since December 2022 had effectively increased the achievement of using online queues through Mobile JKN compared to other collaborative FKRTLs. Apart from that, intensive monitoring and the piloting of FKRTL Champion can also increase the Quality Rate with an average achievement above 80%, and the use of online queues through Mobile JKN effectively shows the efficiency of the average service time at FKRTL outpatient services at FKRTL Champion
Co-Authors Andi Rifka Yuliana Sari Andi Rismaniswati Syaiful Andi Syamsul Bakhri I Gede Bayu Edwin Jenuar ihwan Prasetiya Irawan Yusuf Lily Alfy Sahraini Muhammad Fiqri Adim Muhammad Rezki Rini Oktaviani Najib