Evaluation Of The Causes Of Pending Bpjs Claims Using The Context, Input, Process, Product (Cipp) Method: Evaluasi Penyebab Pending Klaim BPJS Dengan Metode Context, Input, Process, Product (CIPP)

Yeni Devi Yusnita (Program Studi Manajemen Informasi Kesehatan, Universitas Muhammadiyah Sidoarjo)
Umi Khoirun Nisak (Program Studi Manajemen Informasi Kesehatan, Universitas Muhammadiyah Sidoarjo)

Indonesian Journal Health Science and Medicine
Vol. 3 No. 3 (2026): Desember

General Background: Pending BPJS claims remain an administrative and procedural issue in hospital claim management and may be related to documentation, coding accuracy, regulatory compliance, and claim procedures. Specific Background: At Bhakti Dharma Husada Regional General Hospital in Surabaya, pending claims are associated with incomplete clinical documentation, coding issues, administrative discrepancies, and claim management procedures. Knowledge Gap: Previous studies have predominantly used descriptive approaches and have not comprehensively evaluated policies, resources, processes, and outputs related to pending BPJS claims through an evaluative framework. Aims: This study aimed to evaluate the causes of pending BPJS claims using the Context, Input, Process, Product (CIPP) evaluation model. Results: A quantitative cross-sectional analytical approach was conducted with 76 BPJS claim management staff, and the data were analyzed using Partial Least Square Structural Equation Modeling (PLS-SEM) with SmartPLS 4. Context showed a significant path to Input (β = 0.427; p = 0.001), Input showed the strongest path to Process (β = 0.794; p < 0.001), and Process showed a significant path to Product (β = 0.732; p < 0.001). Input was identified as the most dominant component, particularly in administrative completeness, clinical documentation, diagnosis and procedure coding accuracy, regulatory compliance, and coordination among staff. Novelty: This study applies the CIPP model to evaluate the interconnected Context, Input, Process, and Product components in BPJS claim management. Implications: The findings support improvements in claim documentation, coding accuracy, compliance with BPJS policies and hospital SOPs, regular monitoring, and coordination among relevant units. Key Findings Highlights Input showed the strongest path to Process (β = 0.794; p < 0.001). Process showed a significant path to Product (β = 0.732; p < 0.001). Context showed a significant path to Input (β = 0.427; p = 0.001). Keywords : CIPP Evaluation of Pending BPJS Claims at Bhakti Dharma Husada Hospital