Evaluation of The Causes of Pending BPJS Claims Using The Context, Input, Process, Product (CIPP) Method
Evaluasi Penyebab Pending Klaim BPJS Dengan Metode Context, Input, Process, Product (CIPP
DOI:
https://doi.org/10.21070/ups.11718Keywords:
Pending Claim, CIPPAbstract
This study aimed to evaluate factors causing BPJS claim delays using the Context, Input, Process, Product (CIPP) evaluation model at Bhakti Dharma Husada Regional General Hospital (RSUD) Surabaya. A quantitative cross-sectional analytical approach was conducted involving 76 BPJS claim management staff. Results showed positive and significant relationships among all CIPP components. Context significantly influenced Input (β=0.427; p=0.001), indicating that effective identification of claim delay factors supports better input quality. Input had the strongest influence on Process (β=0.794; p<0.001), emphasizing the importance of complete claim documentation, accurate diagnosis and procedure coding, and compliance with claim requirements. Process significantly influenced Product (β=0.732; p<0.001), demonstrating that effective claim management contributes to reducing pending BPJS claims. Overall, Input was the most dominant factor. Improvements should focus on document completeness, coding accuracy, compliance with BPJS policies and SOPs, and strengthened coordination among related units to reduce pending claims.
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A. B. Alfianah, “Analisis Penyebab Pending Klaim BPJS Kesehatan Rawat Inap Di Rumah Sakit Daerah K.R.M.T Wongsonegoro Kota Semarang,” 2024, https://sipora.polije.ac.id/id/eprint/31005
S. Mukaromah and S. Wahab, “Analisis Penyebab Pending Klaim BPJS Rawat JAlan Guna Menunjang Kelancarana Pembayaran Pelayanan Kesehatan Di RSUD Kota Bandung,” PREPOTIF J. Kesehat. Masy., vol. 8, no. 2, pp. 2876–2883, Jun. 2024, doi: 10.31004/prepotif.v8i2.28764.
Universitas Sriwijaya and R. H. Safitri, “Analisis Laporan Arus Kas sebagai Dasar Pengukuran Kinerja Keuangan Rumah Sakit Umum Daerah (studi kasus pada RSUD di Sumatera Selatan),” J. Akunt., vol. 5, no. 2, pp. 125–135, Dec. 2017, doi: 10.24964/ja.v5i2.283.
W. A. Santiasih, A. Simanjorang, and B. Satria, “Analisis Penyebab Pendign Klaim BPJS Kesehatan Rawat Inap Di RSUD DR.RM Djoelham Binjai,” vol. 7, no. 2, 2021.
C. R. D. Sipayung, “Tinjauan Kompetensi Coder Terhadap Keakuratan Dan Ketepatan Pengkodean Menggunakan ICD-10 Di Rumah Sakit Imelda Pekerja Indonesia Medan,” vol. 1, no. 2, 2024.
P. L. R. Ais and A. Akhirruddin, “Analisis Pending Claim Badan Penyelenggara Jaminan Sosial (BPJS) Rawat Jalan pada Rumah Sakit Petrokimia Gresik,” MES Manag. J., vol. 3, no. 3, Dec. 2024, doi: 10.56709/mesman.v3i3.615.
Y. A. Jabbar, “Analisis Penyebab Keterlambatan Pembayaran Klaim Asuransi Swasta Dan Pengaruhnya terhadap Arus Kas Rumah Sakit JIH,” 2025.
N. Heryani and E. Purwaningsih, “Analisis Pengisian Form INA-CBG’s Terhadap Pending Klaim BPJS Di Rumah Sakit Siaga AL Munawwarah Samarinda”.
D. L. Stufflebeam, “Paper read at the Annual Meeting of the American Association of School Administrators Atlantic City, New Jersey February 24, 197,” Feb. 1971.
D. A. N. Sari and C. Cholifah, “Decoding Health Care Complexity with Investigating Pending Claims in Indonesia,” J. Islam. Muhammadiyah Stud., vol. 6, no. 1, Feb. 2024, doi: 10.21070/jims.v6i1.1601.
M. R. Aisy, Elfi, T. Subianto, and F. D. Rahmawati, “Analisis Pending Klaim Rawat Inap BPJS Kesehatan di Rumah Sakit Sumber Hurip Kabupaten Cirebon Tahun 2025,” J. Kesehat. SAINS DAN Teknol. JAKASAKTI, vol. 4, no. 1, pp. 34–41, May 2025, doi: 10.36002/js.v4i1.3805.
M. S. Yulianti and H. Urrahmah, “Analisis Kelengkapan Resume Medis dan Akurasi Koding Terhadap Ketepatan Klaim BPJS Di RSUD Provinsi NTB Tahun 2024,” JUKEJ J. Kesehat. Jompa, vol. 4, no. 1, pp. 336–342, Jun. 2025, doi: 10.57218/jkj.Vol4.Iss1.1561.
N. Ramadanis, W. T. Yuliza, and G. Gusrianti, “Analisis Pelaksanaan Prosedur Klaim Rumah Sakit Pada Badan Penyelenggara Jaminan Sosial (BPJS) Kesehatan Kantor Cabang X,” JIK J. ILMU Kesehat., vol. 8, no. 2, p. 394, Nov. 2024, doi: 10.33757/jik.v8i2.1168.
Yastori and N. F. Khumaira, “Analysis Of Pending Claims As a Basis For Designing An Internal Coding Audit Application In A Hospital,” J. Hosp. Adm. Manag., vol. 6, no. 1, pp. 91–102, Jun. 2025, doi: 10.54973/jham.v6i1.795.
I. M. Irma, “Kebijakan dan Pending Klaim JKN di Rumah Sakit X,” J. Rekam Medis Manaj. Infomasi Kesehat., vol. 4, no. 2, pp. 34–38, Dec. 2024, doi: 10.53416/jurmik.v4i2.201.
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