Authors: 1Sriyani Windarti | 2Alimin Maidin | 3Lalu Muhammad Saleh
1Public Health Program, Post Graduate School
2 Departement of Hospital Management Administration of Public Health Faculty,
3 Departement of Occupational Health and Safety of Public Health Faculty,
Hasanuddin University, Makassar, Indonesia
Email: sriyaniwindarti@gmail.com | aliminmaidin@gmail.com | lalumsaleh@gmail.com
Abstract
The implementation of the Health Social Security Organizing Program (BPJS) is still not fullt understood by the hospital where there are still problems between health services received with filing claims, the submission of claims is not in accordance with the procedures and tariffs in the Cooperation Agreement, causing problems for the hospital. The purpose of this study was to analyze the factors causing the delay in submitting BPJS Health claims to hospitals in Sidenreng Rappang District. This type of research is qualitative with a case study approach. The results showed that the factors causing the delay in filing BPJS Health claims were doctors’ compliance in completing medical resumes and enforcing diagnoses, information technology, SOPs that were guidelines in the process of filing claims, rewards / compensation and supervision by superiors. The suggestion for the hospital is to provide a circular letter to the doctor regarding the obligation to complete the medical resume, complete the SOP for the patient administration service, and increase supervision in each administrative process of Health BPJS claims.
Keywords: Health Social Security Organizing Program (BPJS), hospital, claim, reward, supervision
