Analisis Faktor Penyebab Terjadinya Pengembalian Berkas Pengajuan Klaim BPJS Rawat Inap di Rumah Sakit : Literature Riview

Aprilia, Diah Ayu (2024) Analisis Faktor Penyebab Terjadinya Pengembalian Berkas Pengajuan Klaim BPJS Rawat Inap di Rumah Sakit : Literature Riview. Undergraduate thesis, Politeknik Negeri Jember.

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Abstract

Analisis Faktor Penyebab Terjadinya Pengembalian Berkas Pengajuan Klaim BPJS Rawat Inap di Rumah Sakit : Literatur Review (Analysis of Factors Causing the Return of BPJS Inpatient Claim Files at Hospital : Literature Review) Diah Ayu Aprilia Study Program of Health Information Management Departement of Health ABSTRACT The return of BPJS claim submission files occurs when a file submitted to the verifier for claim processing must be returned by the BPJS verifier due to several factors that can hinder the billing process. This study aimed to analyze the factors causing the return of BPJS inpatient claim submission files at hospitals using HOT-Fit elements: Human, Organization, and Technology. The research method used was a literature review based on inclusion and exclusion criteria. The databases used were the Garuda Portal and Google Scholar. Out of 107 articles identified, 24 met the criteria and were included in the analysis. The findings from the Human element revealed factors such as a lack of knowledge among officers, insufficient motivation, misdiagnosis, incomplete file documentation, and differing perceptions among officers. The Organization element highlighted issues such as unclear job descriptions, the absence of SOPs, and insufficient monitoring and evaluation. The Technology element identified disruptions in the claim application, network errors, and a system not yet integrated with the e-claim application. To address these issues, it is recommended to enhance officers' knowledge regarding BPJS inpatient claims through training, clearly define job responsibilities, implement SOPs, conduct regular monitoring and evaluations, and develop technology related to the claim process. Keywords: BPJS Claim, File Return, Literature Review

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