Factors Causing Delays in Submitting Inpatient BPJS Claims at RSU dr. H. Koesnadi Bondowoso

Nuraini, Novita; Damayani, Desnia Sindi; Wijayanti, Rossalina Adi

doi:10.30604/jika.v6i2.481

Cited by 3 publications

(3 citation statements)

References 5 publications

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“…This not only helps hospitals in obtaining appropriate claims but also supports BPJS policies in providing quality health services to participants. Thus, the speed and accuracy of data reports required by hospitals are crucial factors in maintaining good relations with BPJS and ensuring effective and efficient management in hospital administration and financial aspects (Nuraini et al, 2021).…”

Section: Benefitsmentioning

confidence: 99%

Hospital Management Information Model Hot-Fit: A Systemic Evaluation At Hospital

DWIYANTO

2023

jika

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Management Information System (MIS) for hospital at RSUD dr. Tjitrowardojo Purworejo has not been evaluated comprehensively. Officers lack competence and discipline, need cognitive contribution and leadership support. There is a lack of technological and equipment support. Culture and work patterns influence technology implementation. The study analyses MIS for hospital services at RSUD dr. Tjitrowardojo Purworejo, utilizing interviews and observations. It identifies challenges, develops recommendations, and utilizes a qualitative approach, including case studies and document analysis, to enhance efficiency and quality. This study uses qualitative methods with interviews, observations, case studies, and document analysis to understand the phenomenon of MIS for hospital.RSUD dr. Tjitrowardojo Purworejo faced obstacles in managing MIS due to insufficient staff needs. Management seeks to address this issue with new hires and internal training. Lack of officer discipline and lack of features that match the needs are also a challenge. Management enforces a reward and punishment system, allocates costs, develops networks, and monitors the evaluation of MIS for hospital. Evaluation of MIS for hospital is important, paying attention to input from health professionals, IT personnel, hospital administrators, and patients to identify weaknesses and improve the system for better health services.

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Section: Benefitsmentioning

confidence: 99%

Hospital Management Information Model Hot-Fit: A Systemic Evaluation At Hospital

DWIYANTO

2023

jika

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“…Although this policy aims to answer the basic needs of the community, this policy also bears serious problems. Problems both in terms of financing or late payments are often problems for several partner hospitals of insurance [15].…”

Section: Health Services In Indonesiamentioning

confidence: 99%

Integrating Blockchain for Health Insurance in Indonesia with Hash Authentication

Sutanto

Mulyana²,

Arisgraha³

et al. 2022

JTAER

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The use of blockchain has received great attention in its adoption as a financial instrument in cryptocurrencies. This phenomenon needs to be considered in the sense not only as a form of financial transactions but also in other fields such as health, which is also a challenge for modern society. In addition, several government policies have also supported the provision of health services as a form of improving people’s living standards in the form of insurance. In this study, we try to design the system by using UML diagram and simulate the use of DApps offered by the Vexanium Ecosystem. For example, three basic activities between patients, doctors, and insurance will be simulated in the form of the transaction ledger. This method allows us to speed up the authentication process that previously needed to be performed for a long time with bureaucracy becoming the rule in smart contracts in a matter of minutes. The evaluation of this method will then be compared with eight existing blockchain projects. The result in healthcare processes is cost savings through increased automation, speed, standardization, and efficiency. All of this can be a preliminary analysis of its application in Indonesia, particularly related to the authentication and recording of medical records.

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“…Claims are bills or rewards for services that have been provided, in exchange for the services of doctors, nurses, pharmacists, supports, and so on (Health BPJS, 2014a). In filing claims, BPJS verifies claims submitted by the Hospital (Nuraini et al, 2021). Therefore, the Hospital needs to pay attention to and complete the claims that will be verified in advance to avoid filing claims that are returned or what are called pending claims.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of Pending Claims Bakti Timah Karimun Hospital in Assessing the Effectiveness of the V-Claim Application

Fitriani

Hidayat

2023

JOSR

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The presence of the VClaim application as a form of innovation in industry-based health services 4.0 seeks to create efficiency in submitting claims by the Hospital. However, in its implementation, especially at the Bakti Timah Karimun Hospital, Pending claims still occur which can disrupt the operation of the Hospital. Based on data obtained by researchers, in January-September 2022 there were pending claims with a total INACBGS of IDR 1,537,233,700, - with 1,353 total cases consisting of 7% inpatient care and 3% outpatient care. This study was conducted to assess the effectiveness of the VClaim application in capturing claims that still require confirmation back to the hospital. In addition to improving claim management as well as being used as material for evaluating V Claim applications in submitting claims for JKN participant patients. This research is a non-experimental observational study with qualitative data collection at the Bakti Timah Karimun Hospital. This research uses document review. The occurrence of Pending Claims at RSBT is caused by certain factors both inpatient and outpatient requiring specific improved data to make it easier for verifiers to verify Hospital claims. The VClaim application algorithm in verifying hospital claims against JKN patients is considered effective in measuring the feasibility of claims submitted by FKRTL or hospitals.

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Factors Causing Delays in Submitting Inpatient BPJS Claims at RSU dr. H. Koesnadi Bondowoso

Cited by 3 publications

References 5 publications

Hospital Management Information Model Hot-Fit: A Systemic Evaluation At Hospital

Hospital Management Information Model Hot-Fit: A Systemic Evaluation At Hospital

Integrating Blockchain for Health Insurance in Indonesia with Hash Authentication

Evaluation of Pending Claims Bakti Timah Karimun Hospital in Assessing the Effectiveness of the V-Claim Application

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