IDENTIFICATION OF PENDING CLAIM FACTORS AT X HOSPITAL CITY OF MEDAN IN 2021
FLORA JUNITA SIRAIT (2024) IDENTIFICATION OF PENDING CLAIM FACTORS AT X HOSPITAL CITY OF MEDAN IN 2021 , TESIS, UNIVERSITAS PRIMA INDONESIA
ABSTRAK
The process of reimbursing Covid-19 patients at the hospital requires complete requirements to be able to produce an approved claim status. Claim requirements go through a verification stage by a verifier. If the patient's claim requirements file is incomplete, it will hamper the claiming process, causing pending claims. Overview of covid 19 claims in Medan city submitted for the period March 2020 to November 2021 amounting to IDR 5.046 trillion, of which IDR 4.767 trillion has been verified (94.71%) and IDR 1994 trillion is pending (33,868 cases).
This study aims to identify the factors of pending claims in one of the Covid-19 referral hospitals in Medan City in 2021. Researchers conducted interviews with informants related to Covid-19 claims and the sample used in this study was purposive sampling, namely samples that were considered to represent data for this study by meeting the criteria, namely inclusion and exclusion.
From the results of the study, the factors causing pending in the hospital are updates to the INACBG application, communication between the patient and the Doctor in Charge is less open regarding clinical complaints and a history of traveling out of town or abroad, insufficient number of human resources with a comparison of patients numbering up to thousands with a human resource ratio of 1: 1685 patients and DPJP 1: 96 patients. Recommended training every 6 months to update knowledge about claims, not only on covid-19 claims but can be for regular BPJS claims Develop more structured claim submission flow regulations with the support of adequate facilities and infrastructure and build good communication.
JURNAL
| KATEGORI JURNAL | Jurnal Nasional Terakreditasi |
|---|---|
| TAHUN JURNAL | 2024 |
| VOLUME JURNAL | 6 |
| NOMOR JURNAL | 1 |
| NAMA PENERBIT | Contagion Scientific Periodical Journal of Public Health and Coastal Health |
| NOMOR ISSN/ISBN | 2685-0389 |
| LAMAN PENERBIT (URL) | http://jurnal.uinsu.ac.id/index.php/contagion |
| LAMAN ARTIKEL (URL) | https://jurnal.uinsu.ac.id/index.php/contagion/article/view/18376 |