Optimizing The Management of Claims Pending of Bpjs Inpatients at Hospital X 2018

Novita Nuraini, Rossalina Adi Wijayanti


The  implementation  of  SJSN  system  is  realized  with  the  cooperation  between  the hospital and BPJS. It is then followed by the provision that the hospital is entitled to receive claim payments for services provided to participants then BPJS must pay the claim fee to the health facility. However, if an incomplete requirements file is found, there is a high possibility of returning the claim file so that it may affect negatively to the hospital for impeding the claim payment  process.  A  preliminary  study  at  Hospital  X  showed  that  there  were  a  number  of problems  that  arose  during  the  process  of  managing  inpatient  BPJS  claim  requirements. Moreover, the data revealed that some of the claim files were returned. Thus, the objective of this research is to optimize the management in handling claim pending through POAC. It is a qualitative  in  nature  with  the  intention  in  exploring  the  management  function  that  has  been applied.  The  research  was  conducted  at  Hospital  X  in  May  until  September  2018  with the medical  record  unit  as  the  unit  of  analysis.  The  results  of  this  research  were  a  management strategy  in  the  form  of  Planning,  Orgaization,  Actuating,  and  Controling  in  filling  out  the requirements  file  for BPJS claims  for inpatients at Hospital X. Therefore, by the help of this strategy there will be no incompleteness in filling out the BPJS claim files and the process of disbursement funds can be conducted well. To sum up, BPJS system service requires effective and efficient hospital management and health facilities.

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