STUDI LITERATURE REVIEW ANALISIS KETERLAMBATAN BERKAS KLAIM RAWAT INAP BPJS KESEHATAN DI RUMAH SAKIT

Elyana, Anggun (2021) STUDI LITERATURE REVIEW ANALISIS KETERLAMBATAN BERKAS KLAIM RAWAT INAP BPJS KESEHATAN DI RUMAH SAKIT. Undergraduate thesis, POLITEKNIK NEGERI JEMBER.

	Text (Abstract) Anggun - ABSTRAK.pdf - Submitted Version Available under License Creative Commons Attribution Share Alike. Download (94kB)
	Text (Bab 1 Pendahuluan) Anggun - BAB 1.pdf - Submitted Version Available under License Creative Commons Attribution Share Alike. Download (188kB)
	Text (Daftar Pustaka) Anggun - DAFTAR PUSTAKA.pdf - Submitted Version Available under License Creative Commons Attribution Share Alike. Download (247kB)
	Text (Laporan Lengkap) Anggun - FULL TEXT.pdf Restricted to Registered users only Download (784kB) | Request a copy

Abstract

This claim process is very important for hospitals such as reimbursement for insurance patients who have been treated. Several articles indicate that there are still 43% delays in submitting claim files, while the provisions of BPJS Kesehatan, the files are said to be late if the hospital has not been able to submit 75% of the claim files to BPJS Kesehatan. This study aims to determine the factors that cause delays in the BPJS Kesehatan inpatient claim file at the hospital. The research method used is a literature review. From the literature findings, 17 articles were obtained from 3 databases used in this study, which were sourced from Google Scholar, Portal Garuda, and Crossref. The cause of delay of claims is the lack of completeness of medical records such as diagnoses, DPJP signatures, supporting files, SEP, then other causes are the length of time for the determination of severty levels by the DPJP, the flow of claims is not appropriate between BPJS Kesehatan and hospitals, SOPs are not socialized with related units, disruption of the internet network, SIMRS that have not bridged with the BPJS Kesehatan application (V-claims and E-Claims) so that the data is not synchronized, there is no system that can detect unsaved medical record files, checklists related to administrative requirements, there is no allocation of funds for SIMRS and training. Furthermore, in terms of management, lack of planning related to training and outreach, lack of coordination between related units, implementation of claims that are not in accordance with the applicable SOP, and lack of supervision from the party responsible for claims. The advice is to improve the quality of human resources, need IT support, and coordination between teams.

Actions (login required)

View Item