Classification of Inpatient Pending Claim Factors in the RSB Sartika Asih ERM Transition
DOI:
https://doi.org/10.38035/ijphs.v3i3.1306Keywords:
Factors Claim Pending, Transition, EMR, InpatientAbstract
BPJS claims are the submission of all BPJS patient care costs by healthcare facilities to BPJS. However, the submission of claims may be delayed by the BPJS verifier depending on various factors. This study was conducted at Bhayangkara TK II Sartika Asih Hospital using data on pending inpatient claims from November 2024 to January 2025. The study employed a descriptive, retrospective approach. Non-probability sampling was used to select the entire population. The analysis revealed 327 pending claim files by BPJS. The objective of the research was to identify the factors that caused pending claims during the Electronic Medical Record (EMR) transition period. Data were collected through document analysis and interviews. It was found that the BPJS claims process was not fully EMR-based, resulting in pending claims. Three main factors contributed to this issue: non-compliance with service standards (73%), coding rules (15%), and administrative completeness (11%). These factors disrupt hospital cash flow due to delays in fund disbursement and increase staff workload. To reduce the number of pending claims, it is necessary to routinely evaluate claim data by increasing coordination between related units and promoting compliance with PPK CP to prevent similar mistakes
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