Officer Education Regarding Factors Causing Pending BPJS Claim for Childbirth Cases at Hospital X

Abstract

Completeness of files and accuracy of diagnosis codes play an important role in the smooth verification of claims and become the basis for approval of billing by the Hospital, however, claim files for childbirth cases often become pending during the verification process due to the absence of supporting report sheets, inaccurate diagnosis codes because the diagnosis of childbirth cases is more detailed so that errors often occur in writing the diagnosis code by the coder and the Hospital does not have an internal evaluator. This Community Service Activity aims to provide education to officers regarding the factors causing pending BPJS claims for childbirth cases. This activity uses a socialization and interactive discussion method through three stages, namely the preparation stage, implementation and monitoring of evaluation with a target of 9 casemix teams. From the evaluation results, it is known that the knowledge of casemix officers before and after being given socialization increased by 64%, where before being given education, the average pretest was 59 and after being given education the average posttest score became 97. This activity was carried out as an effort to minimize the occurrence of pending claims for childbirth cases.