PROSEDUR KLAIM ASURANSI JAMINAN KESEHATAN NASIONAL PASIEN RAWAT INAP RSUD KABUPATEN SUKOHARJO

Abstract

ABSTRACT

 

Based on interviews with officers claim the hospital from a preliminary survey of the officers still find obstacles, namely the loss of the reference letter that causes stunted claims procedures and not to the existence of a standard operational procedure that is very important as a reference in carrying out the activities to be carried out properly. The purpose of this research is to know the procedures of Healthcare insurance claims National Inpatient hospital Sukoharjo. Kind of research used descriptive with cross sectional approach. Research methods used are interviews and observations. The subject of research is the officer claims the hospital and officer verifikator BPJS. The object of the research was the implementation of the procedures of Healthcare insurance claims nationally. Data processing technique using the collecting, editing, narrative and descriptive data analysis. The results showed that the completeness of requirements of national health coverage claims inpatients there were constraints, namely the loss of reference letters and fotocopy kartu BPJS. The procedures used are based on the cooperation agreement between the hospital and the main branch of the BPJS Surakarta about health service reference advanced levels for Healthcare participants number: 446/01/2016, in the implementation of the procedure there are still constraints support checks less complete and less obvious read doctors writing on his resume came home as well as reports of operations that are not attached to the disease and the code entry in the programme INA-CBG's do not match. From the results it can be concluded that in filing a claim should be fotocopy card BPJS, fotocopy of ID,fotocopy of KK, SEP, form orders, billing details, medication drugs and alkes BAHP, details of the accommodation and services (billing cashier), supporting the inspection results, resume home. Implementation of claims by hospital claims officers are distinguished into 2 (two) Non-PBI and PBI patients after complete all requirements submitted to verifikator BPJS.

Keyword :  Claim Procedure, JKN Insurance, Inpatient

 

 

ABSTRAK

 

Berdasarkan wawancara dengan petugas klaim rumah sakit dari survai pendahuluan petugas masih menemukan kendala yaitu hilangnya surat rujukan yang menyebabkan prosedur klaim terhambat dan belum adanya standar operasional prosedur yang sangat penting sebagai acuan dalam melaksanakan kegiatan agar bisa terlaksana dengan baik. Tujuan penelitian ini adalah mengetahui Prosedur Klaim Asuransi Jaminan Kesehatan Nasional Pasien Rawat Inap RSUD Kabupaten Sukoharjo.Jenis penelitian yang digunakan deskriptif dengan pendekatan cross sectional. Metode penelitian yang digunakan adalah wawancara dan observasi. Subyek penelitian adalah petugas klaim rumah sakit dan petugas verifikator BPJS. Obyek penelitian adalah pelaksanaan Prosedur Klaim Asuransi Jaminan Kesehatan Nasional. Teknik pengolahan data mengunakan collecting, editing, narasi dan analisis data secara deskriptif. Hasil penelitian menunjukkan bahwa kelengkapan persyaratan klaim Jaminan Kesehatan Nasional pasien rawat inap terdapat kendala yaitu hilangnya surat rujukan dan fotocopykartu BPJS. Prosedur yang digunakan berpedoman pada perjanjian kerja sama antara rumah sakit dan BPJS cabang utama Surakarta tentang pelayanan kesehatan rujukan tingkat lanjutan bagi peserta Jaminan Kesehatan nomor : 446/01/2016, dalam pelaksanaan prosedur masih

 

ada kendala pemeriksaan penunjang kurang lengkap dan tulisan dokter kurang jelas terbaca di resume pulang serta laporan operasi yang tidak dilampirkan dan kode penyakit yang dientri di program INA-CBG’s tidak cocok.Dari hasil penelitian dapat disimpulkan bahwa dalam pengajuan klaim harus terdapa fotocopy kartu BPJS, fotocopy KTP, fotocopy KK, SEP, formulir perintah dirawat, billing obat, rincian obat alkes dan BAHP, perincian akomodasi dan pelayanan (billing kasir), hasil pemeriksaan penunjang, resume pulang. Pelaksanaan klaim oleh petugas klaim rumah sakit dibedakan menjadi 2 (dua) pasien PBI dan Non PBI setelah semua persyaratan lengkap diserahkan ke verifikator BPJS.

Kata Kunci: Prosedur Klaim, Asuransi JKN, Pasien Rawat Inap