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September 5, 2025Journal of Evidence-based Nursing and Public Health.Open Access

Factors contributing to delayed health insurance outpatient claims and administrative optimization strategies

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YYurika

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Overview

Cross-sectional observational study on outpatient claims reveals key inefficiencies, suggesting targeted improvements for health insurance systems.

Key Points

  • 1.5% of outpatient health insurance claims are pending, amounting to IDR 1.84 billion in unresolved finances.
  • Main causes of claim delays include incomplete files (47.1%) and coding discrepancies (38.1%) requiring administrative optimization.
  • Observational analysis at Universitas Indonesia Hospital identifies critical operational gaps affecting health insurance processing.
  • Strategies recommended for improvement include enhanced training for coders and better communication with medical staff.

Cite This Study

Yurika (2025) studied this question.

synapsesocial.com/papers/68bb46bd6d6d5674bccfe95dhttps://doi.org/10.61511/jevnah.v2i02.2025.2211
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