Analisis Faktor Penyebab Pending Klaim BPJS Kesehatan Rawat Inap Di Rumah Sakit Tk.III Baladhika Husada Jember

Maulana, Rita (2024) Analisis Faktor Penyebab Pending Klaim BPJS Kesehatan Rawat Inap Di Rumah Sakit Tk.III Baladhika Husada Jember. Undergraduate thesis, Politeknik Negeri Jember.

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Abstract

Claim files serve as essential documents for submitting claims to BPJS Health. However, the issue of pending claims persists at Tk.III Baladhika Husada Hospital in Jember. The percentage of pending claims from July to December 2023 reached 11.4%, with the highest rate occurring in November at 16.1%. This study aims to analyze the factors causing pending claims in BPJS Health inpatient services at Tk.III Baladhika Husada Hospital using Robbins’ Performance Theory (MOA: Motivation, Opportunity, and Ability). The research is qualitative and data collection methods included interviews, observations, documentation, and brainstorming involving eight participants. Based on the study results, motivation is a factor contributed to pending claims because there is no rewards system implemented. The opportunity factor contributed to pending claims due to the lack of job descriptions for verifiers and data entry staff. Technical challenges, such as unstable internet connections, insufficient human resources were additional factor. The Ability factor contributed to pending claims due to limited experience of the staff (less than five years), and inadequate casemix staff knowledge about submitting BPJS inpatient claims.The conclusion of this study is that the factors causing pending claims for BPJS Health inpatient services are motivation, ability, and opportunity. Proposed improvement measures includes created job descriptions, upgrading and monitoring network speed, recruiting new staff, and providing training to enhance expertise.

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