Article Per Year (5 Year)
p-Index From 2021 - 2026
1.908
P-Index
This Author published in this journals
All Journal Jurnal Manajemen Kesehatan Yayasan RS.Dr. Soetomo Benchmarking: Jurnal Manajemen Pendidikan Islam Care : Jurnal Ilmiah Ilmu Kesehatan Jurnal EMA (Ekonomi Manajemen Akuntansi) Jurnal of Community Health Development (JCHD) Conscilience: Jurnal Penelitian dan Pengabdian Masyarakat JUKEJ: Jurnal Kesehatan Jompa Journal of Global Research in Public Health JARSI Global Journal of Health Administration
Cahyadi, Rachmad
Universitas Muhammadiyah Surabaya
Religion Humanities Biochemistry, Genetics & Molecular Biology Computer Science & IT Dentistry Economics, Econometrics & Finance Education Engineering Environmental Science Health Professions Immunology & microbiology Languange, Linguistic, Communication & Media Law, Crime, Criminology & Criminal Justice Medicine & Pharmacology Nursing Physics Public Health Social Sciences Veterinary Other

Published : 11 Documents Claim Missing Document
Claim Missing Document
Check
Articles

Found 11 Documents
Search

 1   2 
ANALYSIS OF PENDING BPJS CLAIMS ISSUES IN THE CASEMIX UNIT OF RS ISLAM MASYITHOH BANGIL 2025 Junaedi Hasmi A; Rachmad Cahyadi; Mundakir Mundakir
Benchmarking: Jurnal Manajemen Pendidikan Islam Vol 8, No 2 (2024): BENCHMARKING
Publisher : Universitas Islam Negeri (UIN) Sumatera Utara

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.30821/benchmarking.v8i2.28632

Abstract

This study analyzes pending claims within the INA-CBG–based reimbursement process at the Casemix Unit of RS Islam Masyithoh Bangil in 2025. Under Indonesia’s National Health Insurance (JKN), claim submission functions as a critical interface between clinical services and financing governance; disruptions in this process may affect both operational workflows and hospital cash flow. This research employed a descriptive case study design using semi-structured interviews, non-participant observation, and document review. To strengthen the process-based analysis, the study incorporated descriptive quantitative tabulation of monthly verification documents from January–November 2025 at the claim level (unique SEP), covering claim status, service type, pending categories, and submitted value. The dataset recorded 5,272 claims, of which 2,417 were pending (45.8%), with a cumulative pending submission value of IDR 8,427,504,800 and marked month-to-month fluctuations. The composition of pending categories shifted across months, predominantly involving coding rules and service standards, while administrative completeness remained consistently present at a smaller proportion. These findings indicate that pending claims represent a recurrent process output arising from interdependent documentation practices, coding accuracy, and cross-unit coordination within the INA-CBG framework. The study concludes that strengthening internal verification, standardizing documentation and classification, and establishing routine monitoring indicators are essential to improve claim efficiency and organizational sustainability.
Co-Authors Abrisha Agung Wicaksono Aries Kurniawan Cahyo Bagus Setiawan, Heri Djazuly Chalidyanto Edwin Hafiz Elita Novriana Enisa Eva Mufidah Fahrudda, Ansarul Flora Fidelia Heri Cahyo Bagus Setiawan Junaedi Hasmi A Kholifah, Novavani Laila Mundakir Muzzamil Muzzamil Pipit Festi Primasari, Renata Ria Churin Ain Samsulhadi, Wiwid Siti Ashfiyah Sukadiono, Sukadiono Widuri, Sasi Wilianarti, Pipit Festi