Analisis Pending Klaim BPJS Rawat Inap Di Rumah Sakit Qim Batang Tahun 2022

Abstract

Background: BPJS Health can accept claims if they comply with the predetermined flow and procedures and comply with service administration, medical and coding provisions. QIM Batang Hospital still has the most pending claims every month with the highest causes in the coding aspect. Research purposes: The aim of this research is to analyze pending BPJS Inpatient claims at QIM Batang Hospital in 2022. Methods: The type of research is analytical observational with data collection methods through observation. The research sample is pending claim files for October-December 2022. Data analysis is descriptive (univariate analysis) to describe the characteristics of BPJS Health claims. Results: The research results show that of the 3219 claims submitted in Quarter 4 of 2022, there were 176 (5.46%) pending claims with the highest errors in the coding aspect at 68.18% with inaccuracies in code errors, code reselection, and double codes. .