<![CDATA[Pending claims remain a common issue in the BPJS Health reimbursement process and may delay hospital claim payments. This study aimed to analyze the completeness of claim documents, the accuracy of diagnosis coding, and the factors contributing to pending inpatient BPJS claims at RSUD Sidoarjo Barat. A descriptive quantitative study with a prospective approach was conducted using 98 inpatient claim files selected through purposive sampling. Data were collected through observation using a checklist and analyzed descriptively. The results showed that all claim files were administratively complete (100%). Diagnosis coding was accurate in 85% of the files, while 15% were still inaccurate. Claim verification indicated that 86% of claims were eligible for payment and 14% remained pending. Medical factors were identified as the main cause of pending claims, followed by administrative and supporting factors. The findings indicate that complete documents alone cannot prevent pending claims if diagnosis coding is still inaccurate. Therefore, improving coding accuracy and claim verification is necessary to reduce pending BPJS claims.]]>
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