Analysis Of Inpatient Patient Claims Pending To Support The X Hospital's Bpjs Health Claims' Effectiveness

Analysis Of Inpatient Patient Claims Pending To Support The X Hospital's Bpjs Health Claims' Effectiveness

Registration ID: IJNRD_223384

Published ID: IJNRD2406190

DOI: Click Here to Get

Vina Selviana , Irda Sari

Health Claim, BPJS, Efectivity, Inpatient, Analisys Pending Claim.

A pending claim is something that occurs when insufficient or inaccurate data is submitted, making it more difficult for hospitals to file claims to BPJS. Discovering the reasons behind pending inpatient claims is the focus of this research. This study used a qualitative, descriptive methodology with a sample of 1000 files obtained using the Slovin method and a pending file population of 8,931 files from January to March of 2024. According to the study's findings, coding errors accounted for 73% of pending files, incomplete supporting materials for 23% of files, and administrative completeness for 4% of files. The partial completion of the file that needs to be submitted to BPJS, disagreements between the hospital and BPJS over the validity of the diagnosis, and the lack of supporting documentation are the reasons why the claim is still pending. The author recommends that relevant parties and units enhance the completeness and correctness of patient file completion to ensure smooth operation of the claim process. Additionally, frequent meetings and assessments should be held each month to reduce the number of unresolved claims.

Published Paper   E-Certificate

"Analysis Of Inpatient Patient Claims Pending To Support The X Hospital's Bpjs Health Claims' Effectiveness", IJNRD - INTERNATIONAL JOURNAL OF NOVEL RESEARCH AND DEVELOPMENT (www.IJNRD.org), ISSN:2456-4184, Vol.9, Issue 6, page no.b918-b921, June-2024, Available :https://ijnrd.org/papers/IJNRD2406190.pdf

Volume 9 Issue 6, June-2024

Pages : b918-b921

Paper Reg. ID: IJNRD_223384

Published Paper Id: IJNRD2406190

Downloads: 000121143

Research Area: Computer Science & Technology 

Country: Bandung, Jawa Barat, Indonesia

Published Paper PDF: https://ijnrd.org/papers/IJNRD2406190.pdf

Published Paper URL: https://ijnrd.org/viewpaperforall?paper=IJNRD2406190

Journal Name: INTERNATIONAL JOURNAL OF NOVEL RESEARCH AND DEVELOPMENT(IJNRD)

ISSN: 2456-4184 | IMPACT FACTOR: 8.76 Calculated By Google Scholar | ESTD YEAR: 2016

An International Scholarly Open Access Journal, Peer-Reviewed, Refereed Journal Impact Factor 8.76 Calculate by Google Scholar and Semantic Scholar | AI-Powered Research Tool, Multidisciplinary, Monthly, Multilanguage Journal Indexing in All Major Database & Metadata, Citation Generator

Publisher: IJNRD (IJ Publication) Janvi Wave

This work is licensed under a Creative Commons Attribution 4.0 International License and The Open Definition

Call For Paper - Volume 10 | Issue 8 | August 2025

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INTERNATIONAL JOURNAL OF NOVEL RESEARCH AND DEVELOPMENT (IJNRD) aims to explore advances in research pertaining to applied, theoretical and experimental Technological studies. The goal is to promote scientific information interchange between researchers, developers, engineers, students, and practitioners working in and around the world. IJNRD will provide an opportunity for practitioners and educators of engineering field to exchange research evidence, models of best practice and innovative ideas.

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