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All Journal JURNAL PENDIDIKAN TAMBUSAI Islamic Guidance and Counseling Journal Jurnal Ilmiah Edunomika (JIE) REMIK : Riset dan E-Jurnal Manajemen Informatika Komputer Jurnal Kesehatan: Jurnal Ilmu- Ilmu Keperawatan, Kebidanan, Farmasi dan Analis Kesehatan Jurnal Ekonomi Jurnal Teknologi dan Manajemen Industri Terapan Journal of Hospital Administration and Management (JHAM) Jurnal Multidisiplin West Science Jurnal Psikologi dan Konseling West Science West Science Interdisciplinary Studies West Science Interdisciplinary Studies West Science Social and Humanities Studies Psikilogiya Journal
Septin Maisharah K
STIKES Muhammadiyah Bojonegoro
Arts Humanities Computer Science & IT Control & Systems Engineering Decision Sciences, Operations Research & Management Economics, Econometrics & Finance Education Engineering Environmental Science Health Professions Industrial & Manufacturing Engineering Law, Crime, Criminology & Criminal Justice Medicine & Pharmacology Neuroscience Nursing Public Health Social Sciences

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DETERMINAN KETEPATAN WAKTU PENAGIHAN KLAIM JKN: STUDI KASUS PADA RSUD DR. SOERATNO GEMOLONG Wahyu Rizky; Airin Muyasaroh; Amara Valentina; Yogi Catur Putra; Septin Maisharah Karyono
Journal of Hospital Administration and Management (JHAM) Vol 7 No 1 (2026): Journal of Hospital Administration and Management (JHAM)
Publisher : LPPM Universitas Awal Bros

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.54973/jham.v7i1.910

Abstract

Claim submission is a crucial aspect of the healthcare financing system, particularly within the context of the National Health Insurance (JKN) program administered by BPJS Kesehatan. A BPJS Kesehatan claim is the process of submitting invoices for healthcare services provided by hospitals to JKN participants, which are then billed collectively to BPJS on a monthly basis. To this end, hospitals are required to submit complete supporting documents that comply with applicable regulations. This study aims to analyze the factors influencing the timeliness of BPJS Health claims submission at Dr. Soeratno Gemolong General Hospital. The method used in this study is a qualitative method with a descriptive approach, which allows the researcher to gain a deep and comprehensive understanding of the issues occurring in the field. Data collection was conducted through triangulation, which combines observation, in-depth interviews with relevant informants, and a document review. The research findings indicate that delays in claim submission are influenced by several factors, including the lack of specific Standard Operating Procedures (SOPs) in the Medical Records unit that detail the claims process, frequent incompleteness of medical records due to important documents not yet being filled out or signed by the attending physician, human resources for claims processing being sufficiently optimized but still facing challenges at certain times due to incomplete medical records, as well as infrastructure constraints such as a lack of computers, scanners, printers, and internet connectivity issues. These factors significantly hinder the document digitization and verification process, resulting in delays in submitting claims to BPJS Kesehatan.
Co-Authors Afriza Umami Ainil Mardiah Airin Muyasaroh Amara Valentina Annisa, Sri Apriawan Wijayanto, Pramono Arum Pandan Sari A’dawiyah Ismail Budi Sulistiyo Nugroho Bukhari Bukhari Cahyono, Intim Darmawati. R Darsono Darsono Dewi Wulan Sari Dina Destari Dito Anurogo Emdat Suprayitno Farooq Mujahid, Muhammad Umer Habibi Habibi Hartatik Hartatik Hendri Manuhutu Hijrasil Hijrasil I Wayan Adi Pratama Inayatul Mutmainnah Irwan Sugiarto Lathifah Hanum Mardhiyah, Sayang Ajeng Mistarija Mistarija Moh Gifari Sono Mubarok, Ahmad Shofi Mubayyin, Muhammad Afief Muhammad Afief Mubayyin Muhammad Umer Farooq Mujahid Ni Desak Made Santi Diwyarthi Pramono Apriawan Wijayanto Priyana, Yana R, Darmawati. Rahayu, Rita Rusmasari Marisya Sabiruddin, Sabiruddin Sari, Dewi Wulan Shovia Lintina Sono, Moh Gifari Sri Annisa Sulaeman, Ridawati Syatria Adymas Pranajaya Umami, Afriza Wahyu Rizky Yana Priyana YANTI, PENTI DORA Yogi Catur Putra Zandra Dwanita Widodo