Analisis Faktor Penyebab Pengembalian Berkas Klaim BPJS Kesehatan Pasien Rawat Inap Di RSUD Tabanan

Abstract

Return of claim files is one of the requirements for claim files that are declared incomplete by the BPJS. The results of initial observations in October - December 2022 showed that 2,833 claim files were submitted and 165 files were not accepted so they were returned. This study aims to determine the relationship between membership administration factors, service administration factors and health service administration factors on the return of BPJS Health claims. The research design used in this research is quantitative with a cross sectional research type. Methods of data collection by observation and checklist. The sample in this study was 96 BPJS claim files for inpatients in October 2022 – April 2023. The research results obtained were from 65 claims that were not returned and 31 were returned, showing a relationship between membership administration factors, service administration factors and health service administration factors on the return of BPJS Health claims with a p value = 0.0001. The conclusion from this study is that the membership administration, service and health care factors greatly influence the return of BPJS Health claims for inpatients. The advice given is that it is hoped that officers will pay more attention to the suitability of BPJS health claims so that they can improve the quality of the hospital.   Keyword : File Return, BPJS Claims