The impact of BPJS Health Claiming Requirement's completeness on patient's pending claims at Edelweiss Hospital

The impact of BPJS Health Claiming Requirement's completeness on patient's pending claims at Edelweiss Hospital

Registration ID: IJNRD_226805

Published ID: IJNRD2408237

DOI: Click Here to Get

Nazwa Aulia Arsy , Erix Gunawan

Completeness, Pending Claims, BPJS Health

The claim procedure is greatly impacted by the completeness and correctness of the claim requirements. The purpose of this study is to determine how Edelweiss Hospital's Pending Claims are affected by the extent to which inpatient BPJS Health claim standards are met. When claims are returned because the files they sent to BPJS were missing or incomplete, this causes delays in processing. Using a descriptive and quantitative study methodology, a sample of 1,008 claim files from August to October 2023 was taken, and a sample of 85 files was computed using the Slovin formula. According to the study's findings, the fulfillment of claim requirements affects pending claims in 23.4% of cases, with the remaining 76.6% being influenced by other medical factors such procedural incompatibility and technological or administrative issues. The failure to complete medical resume files and other supporting results is the primary reason for the delay in processing this claim. Researchers advise the casemix team to perform routine evaluations to lower the likelihood of pending claims each month and to reach out to the Doctor in Charge of Service (DPJP) to enhance medical resume filling.

Published Paper   E-Certificate

"The impact of BPJS Health Claiming Requirement's completeness on patient's pending claims at Edelweiss Hospital", IJNRD - INTERNATIONAL JOURNAL OF NOVEL RESEARCH AND DEVELOPMENT (www.IJNRD.org), ISSN:2456-4184, Vol.9, Issue 8, page no.c344-c348, August-2024, Available :https://ijnrd.org/papers/IJNRD2408237.pdf

Volume 9 Issue 8, August-2024

Pages : c344-c348

Paper Reg. ID: IJNRD_226805

Published Paper Id: IJNRD2408237

Downloads: 000121160

Research Area: Computer Science & Technology 

Country: Bandung, Jawa Barat, Indonesia

Published Paper PDF: https://ijnrd.org/papers/IJNRD2408237.pdf

Published Paper URL: https://ijnrd.org/viewpaperforall?paper=IJNRD2408237

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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