INFORMATION SYSTEM DESIGN FOR BPJS CLAIM VERIFICATION MODEL FOR INPATIENTS AT XYZ

Abstract

Since January 1, the BPJS (Social Security Administering Body) health insurance program has been in operation. One common challenge faced by hospitals is the discrepancy between hospital claims and BPJS payments, often impacting hospital profitability. XYZ Hospital has experienced this issue in recent months, underscoring the need for an effective BPJS claim verification model for inpatient services.

This study employs a qualitative approach through interviews with respondents directly involved in BPJS inpatient claims. Findings indicate that the most significant issue lies in the incomplete documentation by attending physicians (DPJP) in medical records, followed by challenges in the BPJS verification process at discharge. These insights provide valuable considerations for improving the BPJS claim process and ensuring better alignment between hospital claims and BPJS payments.