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| Advisor(s) | Dr. ELMINA TAMPUBOLON, M.Kes (ET) | |
| Author(s) | TARIGAN, ABRINTA | |
| Issued Date | 2026 | |
| Abstract | The Social Health Insurance Administration Body (SHIAB) claim pending is a major problem faced by hospitals in the Indonesian Case Based Groups (INA-CBGs) payment system. Haji Medan General Hospital recorded an average claim pending rate of 8.76% in the third quarter of September-November 2025. This study aimed to analyze factors associated with SHIAB Health claim pending in inpatient services. Methods: This study used a quantitative cross-sectional design. The sample of this study was 372 patients document with the health insurance claim of health insurance administration board from September – November in 2025. The sample was taken using stratified random sampling technique. Independent variables included Material factor (document completeness and coding accuracy), Machine factor (system response time), and Money factor (INA-CBGs / Indonesian Case Based groups tariff suitability). The dependent variable was claimed pending status. Statistical analysis was conducted utilizing the Chi-Square test, with a significance level set at (α=0.05). The findings indicated a notable correlation between the Material factor and the pendency of claims, as evidenced by a p-value of (0.015), with a higher proportion of pending in incomplete files (24.4%) compared to complete files (14.4%). Machine factor had no significant relationship (p-value=0.131). Money factor also had no significant relationship (p-value=0.689). Conclusion: Material factor (completeness of clinical documents, administration, and diagnosis coding accuracy) is the most associated factor causing the health insurance claim of health insurance administration board in inpatient services with claim pending. Suggestion: Hospitals are advised to improve supervision of claim file completeness and coding staff training. | 1 |
| Item Type | Skripsi | |
| Keywords | Pending Klaim (Claim Pending), BPJSKesehatan (Health Insurence), Rawat Inap (Inpatient), INA-CBGs. | 1 |
| Collection | Fakultas Kesmas, D4-Manajemen Informasi Kesehatan | |
| Publisher | INSTITUT KESEHATAN DELI HUSADA | |
| Submitted Date | 11-08-2026 | |
| Updated Date | 22-09-2026 | |
| URI | No URI | |
| File |
2219001_ABRINTATARIGAN_SKRIPSITERAPAN_D4 .pdf
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