Analisis Faktor Penyebab Keterlambatan Pengajuan Klaim Rawat Inap ke Verifikator BPJS Kesehatan di RSUD Genteng Banyuwangi

Nuraini, Novita and Lestari, Puput Puji (2021) Analisis Faktor Penyebab Keterlambatan Pengajuan Klaim Rawat Inap ke Verifikator BPJS Kesehatan di RSUD Genteng Banyuwangi. Jurnal Kesehatan Politeknik Negeri Jember, 9 (3). pp. 140-149. ISSN P-ISSN : 2354-5852 E-ISSN : 2579-5783

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Abstract

Badan Penyelenggara Jaminan Sosial (BPJS) claims process for inpatient admissions starts from registration until the patient file is entered into the INA-CBGs application. Claim submission under the claims verification technique instructions is limited to the 10th of the following month. RSUD Genteng in filing a claim exceeds the 10th of the following month. In the data of the delay in the medical record file, there is still a delay in submitting the claim file by 55%. The purpose of this research is to analyze the factors causing the delay in submitting BPJS claims for hospitalization to the BPJS verifier in RSUD Genteng, determining the priority of the problem and the improvement effort to the problem. The type of this research is qualitative using a systematic approach based on 7M factors (Man, Method, Materials, Machine, Money, Market and Minute). Methods of data collection using observation, interview, and documentation. Based on the result of NGT that has been done, the priority of problem causing delay is RM refund more than 2x24 hours, internet network is less stable, less discipline officer, no claim submission SOP, DPJD main diagnosis placement and BPJS verification of different perception. Improvement efforts that can be done are to make SOP return of medical records of inpatient and SOP related to claims of inpatient BPJS, repair internet network, conduct coordination meeting among officer related to office discipline and make a special form for correction from BPJS verifier.

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