Analisis Faktor Penyebab Pending Klaim BPJS Rawat Inap di Rumah Sakit Daerah Kalisat Jember

Agustina, Ardila Rintana Putri (2026) Analisis Faktor Penyebab Pending Klaim BPJS Rawat Inap di Rumah Sakit Daerah Kalisat Jember. Undergraduate thesis, Politeknik Negeri Jember.

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Abstract

Claim is a submission of treatment costs that have been given to patients to be billed by the hospital to BPJS. The occurrence of pending claims for 6 months at RSD Kalisat Jember amounted to 260 files out of 3,167 submitted. This study aims to analyze the factors causing pending BPJS inpatient claims at Kalisat Jember Regional Hospital using the 7M management theory. The type of qualitative research with data collection techniques of observation interviews and documentation. The results of the study found that factors causing pending claims are the knowledge of officers who do not know about the regulations for submitting claims and differences in perceptions in providing codification, training that is not fully followed by officers, officer education that is not appropriate, officers who have never had work experience, the unavailability of SOPs used for submitting BPJS claims, incomplete files used for BPJS claim requirements such as medical resumes and supporting examination results, officers who have never attended socialization, claims submitted are delayed, factors that are not the cause of pending claims are the availability of funds used for stationery needs, purchase of work facility tools, and training, the availability of work facilities such as computers and printers are appropriate. Improvement solution efforts Conduct evaluations related to claim implementation, Prepare SOPs, Propose rotating training.

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