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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

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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.
Literature Review Implementasi Human Resource Scorecard dalam Penilaian Kinerja Sumber Daya Manusia di Rumah Sakit Abrisha Agung Wicaksono; Ria Churin Ain; Ansarul Fahrudda; Rachmad Cahyadi
JUKEJ : Jurnal Kesehatan Jompa Vol 5 No 3 (2026): JUKEJ: Jurnal Kesehatan Jompa
Publisher : Yayasan Jompa Research and Development

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.57218/jkj.Vol5.Iss3.2630

Abstract

Peningkatan kualitas pelayanan rumah sakit sangat dipengaruhi oleh efektivitas pengelolaan sumber daya manusia (SDM). Human Resources Scorecard (HRSC) merupakan pendekatan strategis yang digunakan untuk mengukur kinerja SDM melalui perspektif keuangan, pelanggan, proses bisnis internal, serta pembelajaran dan pertumbuhan. Penelitian ini bertujuan menganalisis implementasi HRSC dalam pengukuran kinerja SDM di rumah sakit berdasarkan hasil penelitian terdahulu. Metode yang digunakan adalah literature review dengan pendekatan deskriptif-kualitatif melalui penelusuran artikel pada Google Scholar, Portal Garuda, dan Elsevier tahun 2019–2024. Berdasarkan kriteria inklusi, diperoleh enam artikel yang relevan. Hasil kajian menunjukkan bahwa HRSC mampu membantu rumah sakit dalam menetapkan indikator kinerja yang terukur, meningkatkan efektivitas kerja karyawan, mengidentifikasi kelemahan organisasi, serta mendukung pengambilan keputusan strategis berbasis data. Dengan demikian, HRSC direkomendasikan sebagai instrumen evaluasi kinerja SDM untuk meningkatkan kualitas pelayanan dan daya saing rumah sakit.
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