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August 11, 2025Formosa Journal of Science and Technology

Analysis of Factors Causing Pending Claims for Inpatient JKN Patients Using the Fishbone Diagram Method Approach at Hospital X

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Authors

SRSri RahayuRIRatna Indrawati

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Overview

Qualitative analysis identifies key causes of pending claims in JKN patients, suggesting improvements in coding and SOPs.

Key Points

  • Pending claims for hospitalization reached an average of 18.1% between January and March 2025, highlighting a significant issue.
  • Key factors include inadequate coding quality and quantity, alongside incomplete claim files and lack of proper equipment.
  • Qualitative analysis used secondary data, interviews, and document reviews to uncover root causes of pending claims.
  • Improvements in coding education, equipment quality, and updating SOPs may reduce the rate of pending claims.

Cite This Study

Rahayu et al. (2025) studied this question.

synapsesocial.com/papers/68a360e00a429f797332940fhttps://doi.org/10.55927/fjst.v4i6.130
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  3. 3Factors Causing Delays in BPJS Health Inpatient Claims at Dr. Harjono S Regional General Hospital in Ponorogo Regency2025 · 2 citations
  4. 4Factors contributing to delayed health insurance outpatient claims and administrative optimization strategies2025
  5. 5Analysis Of Accuracy In Determining Diagnosis Coding And Completeness Of Claim Files For Pending Claims Bpjs Kesehatan Inpatient Services Uobk Simpang Lima Gumul Rsud Kediri District2024