ANALISIS PENYEBAB STATUS PENDING KLAIM BPJS KESEHATAN PADA PASIEN RAWAT INAP DI RUMAH SAKIT GRANDMED LUBUK PAKAM TAHUN 2026

The results indicate that pending claims are caused by both "man" and "material" factors. Human (man) factors include inconsistencies in diagnostic coding, illegible physician documentation, delays in clarification, and suboptimal coding training for staff. Material factors involve incomplete claim documentation, delays in completing medical records, a lack of supporting clinical documents for procedures, and readmission cases requiring additional verification. Material factors were identified as the most dominant cause of pending claims. In conclusion, pending claims at Grandmed Lubuk
Pakam Hospital are influenced by suboptimal human resource quality and administrative incompleteness. This study is expected to provide recommendations for the hospital to enhance inter-unit collaboration, provide specialized training for personnel, and ensure rigorous document completeness to facilitate a more effective and timely BPJS Health claim process.