GAMBARAN SISTEM PENGAJUAN KLAIM PASIEN RAWAT INAP BPJS KESEHATAN DI RSUD X KABUPATEN BANDUNG

DESCRIPTION OF THE CLAIM SUBMITTING SYSTEM OF BPJS INPATIENT AT HOSPITAL X IN BANDUNG REGENCY

Abstract

The BPJS Health program has been launched for more than six years, but the process of making claims from the hospital to the BPJS Health Office continues to be developed. In line with the policy changes issued by the BPJS Health regulations, hospitals must also follow these changes, for the smooth payment of claims so that the cash flow of hospital operations is not disrupted. This paper aims to find out the system for submitting claims for BPJS Health inpatients at RSUD X, Bandung Regency. The location of data collection is in the BPJS Health Inpatient Claim Unit, RSUD X Bandung Regency, on June 14-24 2021. The type of paper uses descriptive qualitative research, using data collection techniques of observation, interviews, and documentation. Observations were made at the BPJS Health Inpatient Claim Unit at RSUD X Bandung Regency, then interviews were conducted with two BPJS Health inpatient claims officers, as well as documentation of the claim requirements file. The collected data is then analyzed to draw conclusions. The result of writing is that the claim file and the submission of BPJS Health inpatient claims at RSUD X Bandung Regency are in accordance with the references used, namely Presidential Regulation Number 82 of 2018 and BPJS Health Regulation Number 7 of 2018. However, the SOPs and flowcharts for these activities have not been documented. For this reason, in this paper, it is recommended that the SOP and flowchart of the BPJS Health inpatient claim submission activities is documented. In addition, no less important is the documentation of the Director's Decree for setting regulations as a reference in the activity of submitting BPJS Health inpatient claims at RSUD X, Bandung Regency, so that officers have standards/guidelines as internal references in carrying out their duties.