The Impact of the Rshs E-claim Application on the Accuracy of Outpatient Claim Coding at Hospital X

Abstract

This study examines the role of the RSHS E-Claim application in improving the accuracy of diagnosis coding and the efficiency of BPJS Kesehatan claims submissions at Hospital X. Using the 5M analytical framework of Man, Money, Material, Method, and Machine, this study applies a qualitative descriptive approach based on secondary data obtained from medical records and claims submissions from September to November 2024. The results show that the application significantly reduces coding errors and decreases the number of pending claims. The application assists medical personnel by providing a structured and easily searchable ICD code database, thereby increasing accuracy and minimizing manual entry errors. From a financial perspective, the system optimizes hospital revenue by reducing claim rejections and accelerating the claims process. From a material perspective, the transition to digital documentation reduces reliance on paper-based medical records, thereby lowering operational costs. Methodologically, the application addresses issues such as illegible handwriting, the use of non-standard abbreviations, and misidentification of the primary diagnosis through a well-structured digital interface. As a technological tool, RSHS E-Claim streamlines administrative workflows, encourages a more balanced workload distribution among staff, and ultimately improves hospital claims performance and the quality of digital healthcare services.