<![CDATA[Pending claims involving BPJS Kesehatan remain a challenge in the healthcare financing system in Indonesia. This condition hinders the receipt of JKN funds by healthcare facilities. In general, pending claims arise due to inconsistencies in files, disease and/or action codes, or the determination of medical measures. The same problem also occurred at Tk. III Hospital 03.06.01 Ciremai, Cirebon City, with the continued discovery of pending inpatient BPJS claims in 2025. Based on these conditions, this study aims to describe the causes of pending inpatient BPJS claims based on administrative, coding, and medical aspects. This study aims to describe the causes of those pending claims based on administrative, coding, and medical aspects. A quantitative approach was applied in this study by utilizing secondary data. The sampling technique used was total sampling, namely the entire population of inpatient JKN participants with pending claims with an analysis unit in the form of a BPJS Kesehatan claim recap document used as a research sample with a total of 2,205 data. The results of the study show that out of a total of 15,931 inpatient BPJS Kesehatan claims during 2025, there are 2,205 claims (13.84%) that are pending. The most dominant cause of pending claims came from the medical aspect at 49.01%, followed by the coding aspect at 37.38%, and the administrative aspect at 13.61%.. In the administrative aspect, the most common issue is the incompleteness of supporting documents. Furthermore, in the coding aspect, pending claims are mostly caused by inaccuracies in the diagnosis code. Lastly, in the medical aspect, which represents the largest contribution, the primary cause is the incompatibility of the enforcement of diagnosis and medical measures.]]>
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