Pending BPJS claim to support the quality of outstanding hospital in Muhammadiyah Hospital Bandung

Dola Ramalinda; Encep Yayat; Cika Hasanah; Aulia Safhira; Qori Octaviyani; Selsa Secillia; Niken Juandi; Maheswari Farah Salshabilla

doi:10.53730/ijhs.v6n3.13107

Authors

Dola Ramalinda
dolaramalinda@poltekkesyba.ac.id
Politeknik Kesehatan YBA Bandung, Indonesia
Encep Yayat Politeknik Kesehatan YBA Bandung, Indonesia
Cika Hasanah Politeknik Kesehatan YBA Bandung, Indonesia
Aulia Safhira Politeknik Kesehatan YBA Bandung, Indonesia
Qori Octaviyani Politeknik Kesehatan YBA Bandung, Indonesia
Selsa Secillia Politeknik Kesehatan YBA Bandung, Indonesia
Niken Juandi Politeknik Kesehatan YBA Bandung, Indonesia
Maheswari Farah Salshabilla Politeknik Kesehatan YBA Bandung, Indonesia

Keywords:

education, health, hospital, pending claims, quality outstanding

Abstract

The purpose of the study was to determine the efforts made in handling outpatient pending claims. The method used is descriptive research with a quantitative approach. The population is all BPJS pending claims for outpatients. The sample was calculated using the solvent formulation and obtained 83 pending outpatient BPJS claim files. Research time in February – April 2022 on the Casemix unit. The results show that the outpatient BPJS claim procedure has been running following the Standard Operating Procedures. The causes of pending BPJS outpatient claims, medical administration as much as 86%, inaccurate diagnosis 8%, and incomplete medical resume 4%. Evaluation of pending BPJS Outpatient claims problems, coordinating each section, and improving section performance.

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