FACTORS CAUSING PENDING CLAIMS AT SULTAN THAHA SAIFUDDIN REGIONAL HOSPITAL

Alfita Dewi, Denos Imam Fratama, Mitra Novarini

Abstract


Pending claims are delays in the payment of billed debts aimed at preventing financial disruption. Unresolved claims can interfere with and complicate hospital cash flow, as well as hinder the settlement of hospital obligations. The purpose of this study was to determine the factors causing pending BPJS Health claims in inpatient services at Sultan Thaha Saifuddin Regional General Hospital, Tebo. This research employed a quantitative design with a cross-sectional approach and was analyzed using univariate and bivariate data. The results and conclusions of the study showed that out of 361 claim files, 138 files (38.2%) experienced pending status. The identified factors causing pending claims included inaccurate diagnostic coding (20.8%), incomplete claim documents (16.3%), and unclear diagnostic writing (2.8%). To prevent recurring inpatient pending claims, it is expected that coding officers will be more thorough in entering diagnostic codes into the INACBG’s application, pay greater attention to the completeness of claim documents and clarity of diagnosis writing, as well as participate in training and seminars related to coding and diagnostic establishment.


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