Analysis of Factors Causing Pending BPJS Health Claims at RSUD Mukomuko, Mukomuko Regency in 2024
Date Published : 12 April 2024
Contributors
Siti Mona Amelia Lestari, Silvya Dwi Jayatri, Henny Hanna, Ipik Muhammad Fikri, Sri Rahayu
Author
Keywords
BPJS Kesehatan claims
claim delays
claim management
hospitals
pending claims.
Proceeding
Track
General Track
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Copyright (c) 2024 Proceedings UHAMKA
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Abstract
This study aims to analyze the factors contributing to pending BPJS Kesehatan claims at Mukomuko Regional General Hospital (RSUD Mukomuko), Mukomuko Regency, in 2024. A mixed-methods approach was employed, combining quantitative and qualitative methods to obtain comprehensive findings. Quantitative data were collected from 375 pending BPJS claim files, while qualitative data were obtained through in-depth interviews with 23 informants, including administrative staff, healthcare professionals, and other relevant stakeholders.
The results indicate that the primary causes of pending claims were incomplete documentation, coding errors, and issues related to compliance with service standards. The qualitative findings further revealed that limited understanding of BPJS regulations among hospital personnel and insufficient knowledge of claim coding procedures among claims officers significantly contributed to claim delays. In addition, challenges related to administrative processes and supporting infrastructure were identified as factors affecting the timely submission and verification of claims. This study recommends strengthening staff training programs, enhancing the capacity of hospital information systems, and improving supporting facilities and administrative processes to reduce the incidence of pending claims and improve the efficiency of claim management in the future.
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Siti Mona Amelia Lestari, Silvya Dwi Jayatri, Henny Hanna, Ipik Muhammad Fikri, Sri Rahayu, S. M. A. L. S. D. J. H. H. I. M. F. S. R. (2024, April 12). Analysis of Factors Causing Pending BPJS Health Claims at RSUD Mukomuko, Mukomuko Regency in 2024. Proceedings UHAMKA. https://conferences.uhamka.ac.id/uhamka/paper/view/184