BPJS PENDING CLAIM MANAGEMENT MODEL FOR INPATIENT CARE AT KENDARI CITY HOSPITAL

Abstract This study discusses the BPJS healt delayed claim management model for inpatient care at Kendari City Hospital. This study aims to analyze the facilities, infrastructure, and human resources that support the BPJS healt claim submission process. This research will be conducted at RSUD Kota Kendari, Kendari City Regional General Hospital located at Jl. Brigjend Z.A Sugianto Number 39, Kambu Village, Kambu District, Kendari City. The researcher used a purposive sampling technique, namely selecting informants based on criteria made in accordance with the objectives of the study or selected intentionally or appointed directly to people who are considered to know the most about what is expected. It was found that existing facilities, including computers, servers, and claim applications, were in good condition but often experienced obstacles such as unstable internet connections. In addition, there were challenges in collecting medical resumes and supporting documents that caused delays in claim submission. By involving experienced workers, this study recommends increasing network capacity and adding resources to speed up the claim submission process. The results of this study are expected to contribute to more efficient and effective BPJS Kesehatan claim management in hospitals.