FAKTOR PENYEBAB TERJADINYA PENDING KLAIM BPJS KESEHATAN PASIEN RAWAT INAP DI RSUD IR.SOEKARNO SUKOHARJO

One of the programs held by the Social Security Administering Agency (BPJS) is a health insurance program for the Indonesian people which is implemented through the insurance system. prospective payments are made for health services provided. To get payment, the service provider must submit a claim to BPJS Health, if at the time of file verification there are incompleteness or discrepancies, the file is pending. Based on a preliminary study at RSUD Ir. Soekarno Sukoharjo in the submission of claims in October 2021 as many as 249 files, there are 35 pending files. The purpose of this study is to describe the process of submitting claims for health financing and the factors causing the pending claims of BPJS Health inpatients at RSUD Ir. Soekarno.This research is a descriptive qualitative research. Data collection methods used are observation, interviews and document studies. Data processing by means of data reduction, data presentation, and conclusions. Data analysis was carried out by means of descriptive data obtained from observations, interviews and document studies.The results showed that the submission of claims at RSUD Ir. Soekarno was carried out every month even though there were still pending. The factors causing the pending occurrence are the completeness of the operating report 14 files, the completeness of the medical resume 2 files, the suitability of the SEP with the medical resume 3 files, the cause of the incompleteness because the DPJP has not completed the file. We recommend that the hospital conduct an evaluation in the form of a monthly meeting to discuss the return of claim files that occur every month in order to reduce the number of file returns, especially in cases that keep repeating every month