<![CDATA[Delays in BPJS Kesehatan claim submission remain a significant challenge in the implementation of Indonesia’s National Health Insurance program, particularly in hospitals that rely heavily on BPJS reimbursement, including Ari Canti Hospital, Ubud, Bali. This study aimed to analyze the role of electronic medical record information quality and system quality, the implementation of the five components of the Committee of Sponsoring Organizations of the Treadway Commission (COSO) internal control framework, and the synergy between these factors in improving the timeliness of BPJS Kesehatan claims. A qualitative case study approach was employed using in-depth interviews, observations, and document analysis involving personnel directly engaged in medical record management, internal verification, and claim submission processes. Data were analyzed using the DeLone and McLean Information Systems Success Model and the COSO Internal Control Framework. The findings indicate that information quality and system quality, reflected in completeness, accuracy, reliability, accessibility, and data integration, enhance the readiness of claim documents. Internal verification, as the primary control activity, effectively identifies and corrects documentation discrepancies before claim submission, thereby reducing the risk of pending claims. The synergy between electronic medical records and internal verification contributes significantly to improving claim timeliness. The study implies that strengthening clinical documentation governance, system integration, and continuous internal verification is essential to optimize BPJS Kesehatan claim management in hospitals.]]>
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