DETERMINAN PENYEBAB PENDING KLAIM BPJS PADA PELAYANAN RAWAT INAP DI RSUD KOTA BOGOR

Abstrak

Based on Law no.17 of 2023 Article 4 that everyone has the right to receive health care in accordance with Health Service standards. Bogor Regional Public Hospital as a B-type educational hospital has been facing quite high claims on the inpatient services. In July-December 2022, the number of pending claims on inpatient services amounted to 2610 file claims. pending claim may affect hospital cash flows that will affect the quality of service in competence, service effectiveness, security, and comfort of service. In addition, pending occurrences of claims will impact the claim process next month. This study aims to analyze the pending factors of BPJS claims reviewed from the 5M management elements (Man, Method, Machine, Material, and Money) on the hospital services at Bogor City Regional Public Hospital. The type of research used is qualitative descriptive. Data collection is carried out through observations, interviews, and library studies. Data is then processed and analyzed through data reduction stages, data presentation, and conclusion drawings. The result of the research is that the management element that is a factor of pending claims exists on the man element. The condition of the pending claim of BPJS on the hospital service in Bogor City Regional Public Hospital occurs because of man element that affects the other management element so that the causal factor on man element if studied affects other causes, namely on the material element, method element, and machine elemenet. The recommendation of the solution is given based on the problem that exists in man elements.