INFLUENCE OF ACCURACY OF MAINTENANCE DIAGNOSIS CODES PATHWAYS AGAINST PENDING BPJS CLAIMS AT EDELWEISS HOSPITAL

Nadia Rizki Pratami; Maranata; Ilham Rizky Muharrom

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The International Proceedings aims to publish high-quality scholarly works across multidisciplinary fields, fostering innovation and the exchange of ideas. The scope of the Proceedings includes, but is not limited to, the following three major areas:

Economics and Business Fields: Economics, Digital Business, Accounting, Management, Finance, Communication, HR, Marketing, Business Administration, Public Relations, Strategic Management, Sharia Economics, Sharia Banking, Entrepreneurship, Taxes, Accounting Information Systems, and the like.

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Published Nov 4, 2024

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Vol 4 No 1 (2024): International Conference And Call For Proceedings - Scope of Health

Nadia Rizki Pratami

Politeknik Piksi Ganesha

Maranata

Politeknik Piksi Ganesha

Ilham Rizky Muharrom

Politeknik Piksi Ganesha

Abstract

Pending claims can significantly affect hospitals both financially and operationally. One contributing factor to pending claims is errors in road care diagnostic codes. This study aims to assess how the accuracy of these diagnostic codes impacts pending claims at Edelweiss Hospital. Using a quantitative descriptive approach, the researchers analyzed 24 pending claims out of 6,905 file claims collected from January to April 2024. The analysis revealed that diagnostic code accuracy influenced 80,3% of pending claims, while the remaining 19,7% were affected by other factors such as medical support, long return processes, and file completeness. The study suggests implementing an integrated electronic coding system with electronic medical records (RME) to enhance efficiency and reduce coding errors. Additionally, fostering open communication, coordination, and conducting regular evaluations are recommended to minimize claim delays each month

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