(KTI) REVIEW OF THE COMPLETENESS OF INPATIENT BPJS CLAIM ADMINISTRATION AT PERMATA KUNINGAN HOSPITAL

Health service benefit claims, hereinafter referred to as claims, are requests for
payment of health service costs that have been provided to BPJS Health participants by
Health Service Facilities to BPJS Health. The BPJS Health Verifier will verify files
through BPJS claims submitted by health facilities with the aim of testing the veracity of
health services provided by hospitals to BPJS Health patients in order to maintain service
quality and cost efficiency of health services for BPJS Health participants.
Research Methodology The method used in this research uses descriptive
quantitative. The instrument in this research uses a check-list sheet. The
population in this study was 533 files of inpatient medical records in OctoberDecember 2023, and the sample in this study used simple random sampling taken
using the Slovin formula so that 84 samples were obtained.
The results of research reviewing the completeness of BPJS claims
administration at Permata Kuningan Hospital in October-December 2023, as
many as 72 (85.71%) were declared complete for claim administration
verification, while 12 (14.29%) claims administration verification files were
incomplete due to Insufficient filling in of diagnoses on inpatient medical resumes
Based on research results, the BPJS claim administration file is stated to
be complete in filling out the SEP, Inpatient Order, and medical resume.
It is hoped that this research can be used as input and evaluation material for
hospitals in completing the administration of BPJS claims. The evaluation also aims to be
a means of internal discussion between officers regarding the obstacles faced by officer
Keywords : BPJS, complete administration of BPJS claims, inpatient
care
Bibliography :22(2017-2022)