Factors Causing Pending Claims of BPJS Hospitalization on the Diagnosis of Pneumoni Covid-19 Cases

Abstract

Pending claims are an issue that can impact hospitals, that is, more about delays in the service of doctors and employees. Several factors can cause pending claims, but the main cause of pending cases lies in the completeness of the file on the filling out of the medical resume sheet and the laboratory results that are not recorded. This research is descriptive qualitative with a population of 10 verification employees and a sample of 116 files. It uses interviews with verification officers and observations on pending files—and the identification of 5M management elements (Man, Money, Method, Machine, Materials) to determine what factors cause pending to come from. The results of the study obtained results In 2021; there were pending claims on the diagnosis of pneumoni covid-19 cases in as many as 1167 files, files that had expired were as many as 94 files and files that passed verification were as many as 145 of the total submissions of hospitalization and files for the diagnosis of pneumoni covid-19 cases were as many as 1420 files. If calculated, the percentage for pending cases is 82.18%, passed verification is 11.21% and files that expired as much as 6.61%.