Comparative Analysis of Pending BPJS Kesehatan Claims at Government-Owned and Private Type D Hospitals in 2026
Analisis Perbandingan Pending Klaim Bpjs Kesehatan Pada Rumah Sakit Type D Milik Pemerintah Dan Swasta Tahun 2026
DOI:
https://doi.org/10.21070/ups.11774Keywords:
Comparing claim management, government-owned and private Type D hospitalsAbstract
Abstract: Comparing claims management between government- and privately-owned Type D hospitals is important to evaluate differences in claims governance. This study employed a sequential mixed-methods design, using Chi-square statistical analysis and qualitative analysis through interviews with a snowball-question approach. The study population comprised all pending claim files from the fourth quarter of 2025 and the first quarter of 2026, with a total sample of 69 files. Administrative factors were the leading cause of pending claims in government hospitals (69.6%), higher than in private hospitals (47.8%). Clinical factors accounted for 33.3% (23 cases) in government hospitals and 42.0% (29 cases) in private hospitals. Procedural factors were lower in government hospitals (2.89%) than in private hospitals (17.39%). The findings indicate that administrative, clinical, and procedural factors are interrelated causes of pending claims. Therefore, hospitals should ensure compliance with all three factors when submitting claims.Keywords: BPJS Kesehatan; pending claims; medical records; casemix; Chi-square.
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