ANALISIS SELISIH PENGAJUAN KLAIM DENGAN REALISASI KLAIM PASIEN JKN-KIS DI RUMAH SAKIT IBU DAN ANAK (RSIA) PERMATA BUNDA SOLOK TAHUN 2022

ABSTRACT
This research aims to determine the difference in the realization of claim payments and to find out the factors that cause the difference in the realization of JKN-
KIS patient claims at RSIA Permata Bunda in 2022 and to find out the efforts made by RSIA to overcome this problem. The type of research used is mixed method research (MMR) with quantitative methods and qualitative methods. The data used in this research is primary data, namely data on claims submission and realization of claims submitted by hospitals to BPJS Health. The research results show that the claims submitted by the hospital have not been paid 100% by BPJS Health. The percentage of claims payment achieved, namely claims for INA-CBGs package services, is only 93.1%, claims for chronic medicine services are 97.86%, and claims for ambulance services have reached 100%. Factors causing this discrepancy include administrative factors, confirmation of treatment actions, claims that do not comply with the PMK, diagnostic coding that does not match the submitted claim file. Keywords: Claim Submission, Claim Realization, JKN-KIS Claim, Hospital, BPJS Kesehatan