Claim Analysis of Cost Reimbursement COVID-19 Patient Service to Badan Penyelenggara Jaminan Sosial (BPJS) in health by Hospital

Abstract

The BPJS COVID-19 fee claim is the government's support in accelerating the handling of COVID-19 in Indonesia. BPJS Health data from January to October 2021, the submission of claims for COVID-19 reached 1,345,970 cases with a cost value of 72.3 trillion IDR. Of the claims submitted by the hospital, only 79.07% were following BPJS claim verification or equivalent to 64.1 trillion IDR. There are still 21% of COVID-19 cost claims that require clarification on dispute resolution. Therefore, it is necessary to study the COVID-19 cost claim according to the provisions and find out the obstacles that occur in submitting BPJS claims by hospitals. The method used is descriptive-analytic by using literature searches, reading materials, and scientific journals. The results obtained are that the claim for COVID-19 costs uses the provisions of the tariff per day/cost per day which is regulated in the technical instructions for claiming reimbursement of costs for COVID-19 patient services number HK.01.07/MENKES/5673/2021. The conclusion obtained is that there are still problems with COVID-19 cost claims in the administrative aspect, the limitations of the verifier team, and the integration of the claim submission system.