Jurnal Kesehatan Analisis Pending dan Dispute Klaim Kementerian Kesehatan Pasien Rawat Inap Covid 19

Pending Analysis and Dispute claims of the Ministry of Health of Covid 19 Inpatients

Abstract

Introduction: Covid 19 is an infectious disease that causes community emergency outbreaks. Covid 19 financing is charged to the government through the Ministry of  Health. Submitted by the hospital by completing the claim with the output passed and did not pass verification. Files that do not pass verification are called pending and dispute.

Methods: The method in research on pending analysis and dispute claims of the Ministry of Health Covid 19 Hospitalization used qualitative Research Methods with a descriptive approach. The study used questionnaires and analysis of Covid 19 hospitalization claim data. Population in a study conducted on Casemix division informans.

Results: The results of the research on the claim submission process began with collecting the completeness of the claim file every month for internal verification then the data was inputted into INA-CBG's application to be sent to BPJS processed for 14 days of work. There were obstacles to filing claims including incomplete claim files such as identity cards swab results and resumes. There were constraints on an unstable electronic medical record system. The percentage of pending claims of the Ministry of Health BMC Mayapada by 27% and dispute claims by 7% of the 710 files submitted. Files that were pending and disputed will be followed up by BPJS and the Claims Resolution Team.

Discussion: As advice is necessary to create a written Job Desk and SPO for the claims officer and perform optimal internal verification. Communicate effectively with DPJP and conduct training for claims officers.