FAKTOR - FAKTOR YANG BERHUBUNGAN DENGAN PENDING CLAIM PERSALINAN BPJS KESEHATAN DI RS GRANMED LUBUK PAKAM TAHUN 2025

The results showed that 43 claim files (64.2%) had incomplete administrative documents, 40 files (59.7%) had inaccurate procedure codes, 38 files (56.7%) showed document discrepancies, and 42 files (62.7%) indicated inadequate systems and human resources. The Chi-Square test revealed significant associations between administrative completeness (p = 0.032), procedure coding accuracy (p = 0.018), document conformity (p = 0.006), as well as systems and human resources (p = 0.001) with pending maternity claims. It can be concluded that administrative completeness, procedure coding accuracy, document conformity, and systems and human resources are significantly associated with pending BPJS Health maternity claims. Therefore, improving staff accuracy, strengthening interdepartmental coordination, and conducting regular system evaluations are recommended to minimize pending claims.