Analysis of Factors Causing Delays in The Completion of Bpjs Outpatient Files and Their Impact on The Claims Process at Hospital X

Abstract

The purpose of this study is to analyze the factors that cause delays in outpatient BPJS claims at Hospital X, The research method used is a qualitative method. The data collection method was carried out through unstructured interviews and observations of coding officers and the head of casemix. The results showed that the Man, Machine, Method, Money, and Material (5M) factors contributed significantly to the delay in claims. The quality of labor and work experience of officers affect the speed of claim settlement. In addition, inadequate infrastructure and disorganized file processing are also major causes. Delays in submitting claims have an impact on the reimbursement process from BPJS Kesehatan, which is often hampered due to incomplete documents. This study recommends increased training for officers, infrastructure improvements, and evaluation of administrative flow to improve the efficiency of claims file management.