Identifikasi Faktor Penyebab Pending Claim Rawat Inap pada Pasien BPJS di RSUD Sultan Syarif Mohamad Alkadrie Kota Pontianak

Identification of Factors Causing Pending Claims for Hospitalization in BPJS Patients at RSUD Sultan Syarif Mohamad Alkadrie Pontianak City

Abstract

Introduction: The phenomenon of many delayed claims occurring at Sultan Mohamad Alkadrie Regional Hospital causes the payment of claims from BPJS Kesehatan to RSUD Sultan Syarif Mohamad Alkadrie to be late and detrimental to the hospital’s finances, as well as resulting in delays in payment of medical services for all health workers and payment of casual daily workers’ salaries, which is feared will affect activities. Services and financing at RSUD Sultan Syarif Mohamad Alkadrie. Therefore, the causes of pending claims that occur at RSUD Sultan Syarif Mohamad Alkadrie need to be analyzed, identified, and corrected, so that researchers are interested in carrying out research regarding the Factors that Cause Pending Claims for Inpatient BPJS Patients at RSUD Sultan Syarif Mohamad Alkadrie.

Methods: This research uses a qualitative method with a descriptive approach to describe the phenomenon of pending claims at the Sultan Syarif Mohamad Alkadrie Hospital, Pontianak City, using a purposive sampling technique.

Results: The results show that five factors cause the first to be a lack of human resources in medical record installations, the second to be a lack of equipment to support claims work, the third to be less efficient in the claim flow, the fourth to be incomplete claims files, and the fifth to be an uncomfortable working environment for officers. The recommendations given are increasing human resources, procuring equipment to support claims work, changing the placement of internal claims verifiers, and physical changes to the work environment of claims officers.

Discussion: The purpose of this research is to identify the factors that cause pending claims to occur at Sultan Syarif Mohamad Alkadrie Regional Hospital