Pelatihan dan Pendampingan Pengelolaan Berkas Klaim BPJS Kesehatan untuk Menurunkan Angka Pending Klaim Rawat Jalan di Rumah Sakit Umum X
Main
Mulyana Mulyana*
Masriani Situmorang
Jihhan Naailah Zhahara
Rifdah Salsabila Hasibuan
Nur Erika
Aliya Afrida
BPJS Health claims are one of the main sources of funding for hospitals, which are highly dependent on the accuracy and completeness of claim files. A common problem is the high number of pending claims or claim files returned by BPJS Health due to administrative discrepancies, incorrect diagnosis and procedure coding, and incomplete supporting documents. This community service activity aims to improve the competence of casemix and medical record officers through training and mentoring in managing BPJS Health claims in order to reduce the number of pending outpatient claims at General Hospital X. The activity was carried out in stages: preparation, training and mentoring, and evaluation. The evaluation was conducted by measuring staff understanding through pre-tests and post-tests and comparing the percentage of pending claims before and after the community service activity. The results of the activity showed an increase in the average understanding score of officers from 62.5 to 86.3 and a decrease in the percentage of pending claims from 21.4% to 11.2% during the evaluation period. These findings indicate that training and mentoring in managing BPJS Kesehatan claims have a positive impact on partners and are recommended to be implemented continuously to maintain the quality of claim management in hospitals.
Adji, I. S., Alghozi, M. H., Nabilah, A., Arifinnia, S. G. S., Hanief, S. M. R., & Rosyita, F. J. (2025). Manajemen Strategik dalam Antisipasi Klaim Pending Badan Penyelenggara Jaminan Sosial di Rumah Sakit Pemerintah. Jurnal Penelitian Kesehatan" SUARA FORIKES"(Journal of Health Research" Forikes Voice"), 16(4), 1085–1091. https://doi.org/10.33846/sf16438
Ais, P. L. R., & Akhirruddin, A. (2024). Analisis Pending Claim Badan Penyelenggara Jaminan Sosial (BPJS) Rawat Jalan pada Rumah Sakit Petrokimia Gresik. Jurnal Manajemen MES, 3(3), 749–760. https://doi.org/10.56709/mesman.v3i3.615
Ernaman Putri, R. S., Putri, W., & Wahyudi, W. (2025). Sosialisasi Pelaksanaan Assembling dalam Meminimalisir Ketidaklengkapan Pengisian Rekam Medis di RS Awal Bros Botania Batam. PORTAL RISET DAN INOVASI PENGABDIAN MASYARAKAT, 4(3), 111–115. https://doi.org/10.55047/prima.v4i3.1814
Farhansyah, F., Cahyani, H., & Amanda, J. (2024). Faktor Penyebab Pending Klaim Berkas BPJS Kesehatan Pelayanan Rawat Jalan Di Rumah Sakit X. Jurnal Kesehatan Tambusai, 5(3), 8712–8722.
Farhansyah, F., & Nhifvellast, R. (2021). Sosialisasi Sistem Penyimpanan Rekam Medis di Klinik Panacea. JOURNAL OF SUSTAINABLE COMMUNITY SERVICE, 2(1), 47–51. https://doi.org/10.55047/jscs.v2i1.436
Prasetya Eka, A., & Budiarti, A. (2024). Faktor Penyebab Pending Klaim BPJS Kesehatan di Rumah Sakit Rafflesia Kota Bengkulu. Sekolah Tinggi Ilmu Kesehatan Sapta Bakti.
Puspaningsih, M., Suryawati, C., & Arso, S. P. (2022). Evaluasi Administrasi Klaim Bpjs Kesehatan Dalam Menurunkan Klaim Pending. Journal of Syntax Literate, 7(6).
Putri, A. F., & Novratilova, S. (2025). Analisis faktor penyebab pending klaim BPJS rawat inap di Rumah Sakit Mardi Waluyo Lampung. Jurnal Kesehatan Tropis Indonesia, 3(4), 244–270. https://doi.org/10.63265/jkti.v3i3.127
Ulil Amri, A. A., & Nurwahyuni, A. (2024). Analisis klaim pending, verifikasi dan audit pascaklaim Jaminan Kesehatan Nasional. Jurnal Ekonomi Kesehatan Indonesia, 9(2), 4. https://doi.org/10.7454/eki.v9i2.1132
Utami, Y. T., & Rosmalina, N. (2019). Hubungan Kelengkapan Informasi Medis Dengan Keakuratan Kodetuberculosis Paruberdasarkan ICD-10 Pada Dokumen Rekam Medis Rawat Inap di BBKPM Surakarta. SMIKNAS, 146–152.
Wahyuni, F. S., Yudhana, A., & Dewi, W. P. (2024). Analysis of Accuracy in Determining Diagnosis Coding and Completeness of Claim Files for Pending Claims BPJS Kesehatan Inpatient Services UOBK Simpang Lima Gumul RSUD Kediri District. Journal of Hospital Management and Services, 6(1), 6–12. https://doi.org/10.30994/jhms.v6i1.60
Zahra, P. A. (2026). Kelengkapan Dokumen Administrasi Klaim Rawat Inap Pada Kasus Partus Sectio Caesarea Terhadap Pending Klaim Bpjs Kesehatan Di Rsud Bandung Kiwari. Journal of Medical Record Student (JMeRS), 4(1), 88–97.
