Hospital X in the South Tangerang serves BPJS outpatients, every month sending claims for outpatient services to BPJS Health, but not all submitted claims are processed by BPJS Health.There are a number of claims that are returned because they are not in accordance with the provisions for submitting claims.This study aims to overview the causes of claims returns and follow-up the returned claims of Hospital X.The method used in this study is a quantitative description where the documents studied are claim documents returned by BPJS Health to Hospital X in the period of September Dryer Machine Parts 2020 to August 2021.A total of 3795 claim documents were returned; there were 3194 claims returned due to repeated control indicated factors, while the rest were due to physiotherapy service indication factors more than 8 times per month, errors in determining the procedure code, incomplete supporting files and other reasons.
After hospital X corrected the returned claims, there were 974 claims that could not be resubmitted, so these claims were considered as a cost to Hospital X.The cause of the claim not being resubmitted was because the patient eligibility letter was printed Medical and Ambulatory supplies / Clinical Laboratory more than once.This article offers suggestions to minimize patient visits in the near future and to follow the latest policy developments from BPJS Health regarding outpatient claims.