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| Advisor(s) | TARIGAN, USAHA SATRIA PRATAMA | |
| Author(s) | MENDROFA, NELVIANUS | |
| Issued Date | 2026 | |
| Abstract | Analysis of Factors Causing Pending BPJS Health Claims in the Medical Record Installation of Bethesda Gunungsitoli General Hospital Based on the Perspective of Medical Record Officers (supervised by Mr. Usaha Satria Pratama Tarigan, M.K.M.) The National Health Insurance Program (JKN) organized by BPJS Health is one of the government's efforts to provide health protection for the community. In implementing the JKN program, hospitals are required to manage health service administration, including the process of submitting health service financing claims to BPJS Health. However, in the claim submission process, problems are still found in the form of pending claims that can hinder the payment process to hospitals. Pending claims can be caused by several factors, including incomplete medical record documents, inaccurate diagnosis and procedure coding, administrative discrepancies, and obstacles in the claim management process by related officers. This study aims to analyze the factors causing pending BPJS Health claims in the Medical Record Installation of Bethesda Gunungsitoli General Hospital based on the perspective of medical record officers. This research used a qualitative method with a descriptive approach. Data collection was conducted through in-depth interviews and observations of medical record officers involved in the BPJS Health claim management process. Data analysis was carried out through data reduction, data presentation, and conclusion drawing. Data validity was tested using source triangulation and technique triangulation. The results of this study indicate that the factors causing pending BPJS Health claims include human resource factors, completeness and accuracy of medical record documents, implementation of procedures or Standard Operating Procedures (SOPs), information system factors, and communication and coordination between related service units. These factors may result in claim returns or delays by BPJS Health for correction and completion. The conclusion of this study shows that BPJS Health claim management requires competent medical record officers, complete and accurate medical record documentation, optimal implementation of SOPs, and effective coordination between related units. Improvement efforts are needed to reduce pending claims and improve the effectiveness of the BPJS Health claim process at Bethesda Gunungsitoli General Hospital. | 1 |
| Item Type | Skripsi | |
| Keywords | Pending Claims, BPJS Health, Medical Records, Causative Factors, Medical Record Officers. | 1 |
| Collection | Fakultas Kesehatan Masyarakat, S1-Kesehatan Masyarakat | |
| Publisher | INSTITUT KESEHATAN DELI HUSADA | |
| Submitted Date | 19-10-2026 | |
| Updated Date | 20-10-2026 | |
| URI | No URI | |
| File |
Nelvianus Mendrofa_Skripsi_25199062 (2).pdf
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