Analysis of the Completeness of BPJS Patient Surgical Operation Forms to Support Smooth Claim Processing

Abstract

Healthcare services provided by the BPJS require complete and accurate administrative documents, one of which is the medical action report form. This study aims to assess the completeness of these forms among BPJS patients at Bhayangkara Hospital Class II Sartika Asih Bandung from January to March 2025. This study used a mixed method, where quantitative data were obtained through document audits and qualitative data were obtained from interviews with healthcare workers. A total of 91 medical record files were analyzed using a systematic random sampling method and the Singaribuan Formula to determine the sample proportion for each month. The analysis results showed that the patient identity, diagnosis, and surgical procedure elements had a completeness level of 100%. The DPJP component was filled in 96.7%, while the time of surgery had the lowest completeness at 76.92%. Interview results indicated that incompleteness was caused by a lack of follow-up from the administration and the urgent surgical situation, so recording was not prioritized. These findings emphasize the importance of improving administrative management, developing adequate SOPs, and increasing discipline in medical documentation. These improvements are expected to streamline the BPJS claims process and improve the quality of hospital services.