Pending Claim Correlation with Claim Completeness Requirement Bpjs Outpatients Arya Medika Hospital

Abstract

BPJS financing claims require complete claim
requirements, while incomplete BPJS claim requirements
cause a pending claim. This research is to find out
the correlation between BPJS claim requirements and
pending claims in outpatients at Ariya Medika Hospital in
2019. This research uses quantitative descriptive method
with cross sectional approach. The population of 2136
dossiers of outpatient BPJS patients who made financing
claims in April. Sampling using a different test formula
proportion of 32 files. Using univariate and bivariate
analysis with Chi-Square test. The results showed that of
the 32 patient files consisting of 16 (50%) each. Found
the majority of incomplete documents as many as 20
files (62.5%). From the bivariate test results it was found
that the majority of documents that experienced pending
claims were from groups whose file requirements were
incomplete, namely 14 files (87.5%). While the majority
of groups that were not pending were 10 (62.5%) files.
Chi square test results obtained p value = 0.009 which
means there is a correlation between the completeness of
the BPJS claim requirements with the Pending Claim. To
reduce the number of files pending claim, it is necessary to
collaborate with the first hospital and referral, as well as
patient awareness in completing the claim requirements
document. The hospital can also maximize education
in the form of publication of BPJS clim completeness
requirements.