ANALYSIS OF FACTORS CAUSING PENDING BPJS HEALTH CLAIMS IN OUTPATIENT SERVICES OF INTERNAL MEDICINE POLYCLINIC AT BRANCH OF CABANGBUNGIN REGIONAL GENERAL HOSPITAL

Abstract

BPJS claim is a submission of all BPJS patient care costs by the Hospital to BPJS Kesehatan, carried out collectively and billed to BPJS Kesehatan every month through a verification process. The file verification process includes 2 things, namely claim files and claim administration. Pending claims are claim returns where there is no agreement between BPJS Kesehatan and FKRTL regarding coding rules, but settlement is carried out in accordance with the provisions of the regulations - invitations. So if there is a pending claim file, it will have an impact on the Hospital's cash funds, and result in disruption of problems in paying the claim. The purpose of this study was to determine the Analysis of Factors Causing Pending BPJS Kesehatan Claims in Outpatient Services for Internal Medicine Polyclinics at the Cabangbungin Regional General Hospital based on research conducted at the Cabangbungin Regional General Hospital, Bekasi Regency in 2025.