Review of Pending Inpatient Claims to Improve the Effectiveness of BPJS Health Claims at Muhammadiyah Hospital Bandung

Vollständiger Abstract

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Pending inpatient claims under BPJS Kesehatan represent a frequent issue during the hospital claim submission process. Such situations can lead to delayed payments and reduce the overall effectiveness of the BPJS Kesehatan claims process. Pending claims are generally caused by incomplete medical records or supporting medical documentation, administrative errors, and discrepancies between diagnosis and procedure codes. Therefore, evaluating the causes of pending claims is essential to improving the effectiveness of BPJS Kesehatan claims. This study aims to identify the causes of pending inpatient claims and the specific types of errors involved, as well as to examine the measures taken by RS Muhammadiyah Bandung to reduce the incidence of pending claims and enhance claim effectiveness. The findings are expected to provide insight into the causes of pending inpatient claims, common administrative errors, and potential improvement strategies for the hospital.