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

Registration ID: IJNRD_223384

Published ID: IJNRD2406190

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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

Vina Selviana & Irda Sari (June-2024). Analysis Of Inpatient Patient Claims Pending To Support The X Hospital's Bpjs Health Claims' Effectiveness. INTERNATIONAL JOURNAL OF NOVEL RESEARCH AND DEVELOPMENT, 9(6), b918-b921. 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: 000122039

Research Area: Computer Science & Technology 

Author Type: Foreign Author

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)

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