Examination of Pending Elements for Inpatient Service Matters of BPJS Kesehatan at X Hospital

Registration ID: IJNRD_223584

Published ID: IJNRD2406427

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Ratna Laelasari, Erix Gunawan

5M, BPJS Claim, Inpatient

BPJS Health is an organization responsible for social security programs in Indonesia. The BPJS Health claim process occurs when the hospital submits treatment costs for BPJS Health participants to BPJS Health, which is then paid by BPJS Health every month collectively. Funding for health cannot be underestimated by the JKN program run by BPJS Health through the claims process. However, not all claims submitted can be claimed immediately, because there are claim statuses that may or may not be feasible. This study aims to find factors that cause delays in inpatient BPJS claims at Hospital X. In this study, a qualitative approach with descriptive methods was applied. Data was collected through interviews and observations. From the results of this research, 79 samples of inpatient files were found to have eligible claims of 59 (75%) and pending claims of 20 (25%). There are also pending BPJS inpatient claims seen from the 5M management element, namely factors such as a lack of officers, lack of understanding of officers regarding the BPJS claims process. This machine factor occurs because the existing scanning equipment and network are still insufficient. The method factor is that this hospital already has an SOP but lacks understanding of the BPJS claims process. The money factor is that the existing budget is still insufficient for facilities in the claims section. Material factors, namely incomplete filling in of files and caused by human error in entering the wrong data.

Published Paper   E-Certificate

Ratna Laelasari & Erix Gunawan (June-2024). Examination of Pending Elements for Inpatient Service Matters of BPJS Kesehatan at X Hospital. INTERNATIONAL JOURNAL OF NOVEL RESEARCH AND DEVELOPMENT, 9(6), e287-e291. https://ijnrd.org/papers/IJNRD2406427.pdf

Volume 9 Issue 6, June-2024

Pages : e287-e291

Paper Reg. ID: IJNRD_223584

Published Paper Id: IJNRD2406427

Downloads: 000122256

Research Area: Computer Science & Technology 

Author Type: Foreign Author

Country: Bandung, Jawa Barat, Indonesia

Published Paper PDF: https://ijnrd.org/papers/IJNRD2406427.pdf

Published Paper URL: https://ijnrd.org/viewpaperforall?paper=IJNRD2406427

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

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