Faktor-Faktor Penyebab Tertundanya Klaim Jaminan Kesehatan Nasionial (JKN) Pasien Rawat Inap di Rumah Sakit X Kab. Tangerang Tahun 2024

Factors Causing Delay in Claims for National Health Insurance (JKN) of Inpatients at Hospital X, Tangerang Regency In 2024

Abstract

Background: JKN Health Claim is a process carried out by the Hospital to submit a bill for JKN participant treatment costs. JKN claims can be categorized into two categories, namely successful claims which are claims processes that have been successfully completed and pending claims which are claims processes that are delayed. Files that are declared incomplete by JKN Health are a factor causing delays in claims which have an impact on delays in claim payments. Objective: To find out how the inpatient claim process is, to find out the factors causing delays in national health insurance (JKN) claims for inpatients at Hospital X in Tangerang Regency. Method: This study is a descriptive study with a qualitative approach. In this study, in-depth interviews were conducted with 4 informants. Data collection used interview techniques, observation and document review. Results: Based on the results of the study, it shows that the factors causing delays in National Health Insurance (JKN) claims for inpatients are Man: lack of number of officers, lack of accuracy and skills of officers, length of service of officers less than 1 year. Material: incomplete filling in of patient medical record files. Method: there is no SOP yet, officers do not work according to SOP. Machine: Unstable internet network. Conclusion: Factors causing delays in claims for National Health Insurance (JKN) for inpatients with a fishbone diagram include Human Factors: limited number of human resources in Inpatient registration, lack of discipline of DPJP doctors in filling out medical resumes and signatures, assembling officers must be careful and skilled in recapitulating claim files, the coding doctor's work period of less than 1 year results in data input errors and inaccurate coding. Material Factors: the results showed that pending claims were caused by incomplete or inaccurate inpatient claim files. Method Factors: Hospital X, Tangerang Regency already has a Standard Operating Procedure (SOP) but the current SOP has not been approved by the director. Machine Factors: originating from internet network disruptions and power outages.