Islamida, Desintya Belarisma (2025) Analisis Faktor Penyebab Pending Klaim BPJS Rawat Jalan di Rumah Sakit Tingkat III Baladhika Husada Jember Tahun 2025. Undergraduate thesis, Politeknik Negeri Jember.
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Abstract
Baladhika Husada Level III Hospital Jember in 2024 faced a significant increase in pending outpatient health insurance claims, showing fluctuating and rising trends. The main causes of pending claims included incomplete documentation (345 cases), errors in diagnostic or procedural coding (5 cases), and repeated patient visits (441 cases). This study aimed to analyze the factors contributing to pending outpatient health insurance claims using Robbins. A qualitative research design was applied, with data collected through interviews, observation, and documentation. Respondents consisted of two coding officers, two attending physicians, one head of the casemix unit, three outpatient nurses, and three outpatient midwives. Findings revealed that ability was influenced by limited knowledge of claim procedures and coding among staff. Motivation was affected by low work drive due to the absence of a reward and punishment system. Opportunity factors arose from the lack of specific procedures for outpatient claims, coding processes, and checklist forms for document completeness. It can be concluded that all three variables contributed to the occurrence of pending claims. Recommendations for improvement include conducting routine training, implementing a reward–punishment system, developing clear procedures, and using checklist forms prior to claim submission.
| Item Type: | Thesis (Undergraduate) | ||||||
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| Uncontrolled Keywords: | BPJS Kesehatan, kinerja, pending klaim, rawat jalan | ||||||
| Subjects: | 340 - Rumpun Ilmu Kesehatan > 370 - Ilmu Keperawatan dan Kebidanan > 373 - Administrasi Rumah Sakit 340 - Rumpun Ilmu Kesehatan > 350 - Ilmu Kesehatan Umum > 358 - Ilmu Asuransi Jiwa dan Kesehatan 340 - Rumpun Ilmu Kesehatan > 350 - Ilmu Kesehatan Umum > Sistem Informasi Kesehatan |
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| Divisions: | Jurusan Kesehatan > Prodi D4 Manajemen Informasi Kesehatan > Tugas Akhir | ||||||
| Depositing User: | Desintya Belarisma Islamida | ||||||
| Date Deposited: | 08 Oct 2025 03:59 | ||||||
| Last Modified: | 08 Oct 2025 04:01 | ||||||
| URI: | https://sipora.polije.ac.id/id/eprint/47043 |
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