Literature Review on Causes of Claim Return for Inpatients’ Social Security for Health Agency

Claim returns for Social Security Health Agency (BPJS Kesehatan) always become a cliché in the field of health budgeting National (JKN) era. Some studies have examined factors causing claim return; however, issue has not been figured out yet because every hospital different troubles. This study was conducted to identify troubles possibly faced by hospitals. qualitative at type-C owned government Central Java province. In-depth interviews were with assembling staff, coder, case-mix officer, internal verificatory, and head medical record unit. Results showed that occurred information system had integrated e-claim v-claim apps. The lacked number officers, old-fashioned about INA CBGs payment scheme from officers including coders, doctors, other officers; also inadequate supporting facilities such as echocardiography endoscopy, its staff lack work experience training coders. Managerial support is tremendously required solve issues related BPJS Kesehatan.