Paper Title
The impact of BPJS Health Claiming Requirement's completeness on patient's pending claims at Edelweiss Hospital
Article Identifiers
Registration ID: IJNRD_226805
Published ID: IJNRD2408237
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Authors
Keywords
Completeness, Pending Claims, BPJS Health
Abstract
The claim procedure is greatly impacted by the completeness and correctness of the claim requirements. The purpose of this study is to determine how Edelweiss Hospital's Pending Claims are affected by the extent to which inpatient BPJS Health claim standards are met. When claims are returned because the files they sent to BPJS were missing or incomplete, this causes delays in processing. Using a descriptive and quantitative study methodology, a sample of 1,008 claim files from August to October 2023 was taken, and a sample of 85 files was computed using the Slovin formula. According to the study's findings, the fulfillment of claim requirements affects pending claims in 23.4% of cases, with the remaining 76.6% being influenced by other medical factors such procedural incompatibility and technological or administrative issues. The failure to complete medical resume files and other supporting results is the primary reason for the delay in processing this claim. Researchers advise the casemix team to perform routine evaluations to lower the likelihood of pending claims each month and to reach out to the Doctor in Charge of Service (DPJP) to enhance medical resume filling.
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How To Cite (APA)
Nazwa Aulia Arsy & Erix Gunawan (August-2024). The impact of BPJS Health Claiming Requirement's completeness on patient's pending claims at Edelweiss Hospital. INTERNATIONAL JOURNAL OF NOVEL RESEARCH AND DEVELOPMENT, 9(8), c344-c348. https://ijnrd.org/papers/IJNRD2408237.pdf
Issue
Volume 9 Issue 8, August-2024
Pages : c344-c348
Other Publication Details
Paper Reg. ID: IJNRD_226805
Published Paper Id: IJNRD2408237
Research Area: Computer Science & TechnologyÂ
Author Type: Foreign Author
Country: Bandung, Jawa Barat, Indonesia
Published Paper PDF: https://ijnrd.org/papers/IJNRD2408237.pdf
Published Paper URL: https://ijnrd.org/viewpaperforall?paper=IJNRD2408237
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