Operational Analysis of BPJS Claim Duration: Coding Accuracy, Medical Record, Claim Document

Abstract

The pending Health Social Security Administering Body (Badan Penyelenggara Jaminan Sosial/BPJS) claims remain a challenge affecting hospital operational continuity. This study aimed to determine and analyze the partial associations of Diagnosis Coding Accuracy, Medical Record Completeness, and Claim Document Completeness with BPJS claim duration, as well as their joint contribution to model fit. A quantitative approach with descriptive and verificative methods was applied using secondary data from 365 inpatient claim files from October-December 2025, selected through proportionate stratified random sampling. Data were analyzed using ordinal logistic regression, with hypotheses tested using the Wald test for partial associations and Model Fitting Information for joint model fit. Descriptive analysis showed that Diagnosis Coding Accuracy was appropriate in 91.2% of files, Medical Record Completeness in 90.1%, Claim Document Completeness in 97.5%, and BPJS claim duration was categorized as fast in 90.7% of files. Diagnosis Coding Accuracy was the only independent variable that showed a statistically significant partial association with BPJS claim duration, whereas Medical Record Completeness and Claim Document Completeness did not show statistically significant partial associations. Jointly, the three predictors provided a significantly better-fitting model than the intercept-only model.

Keywords

BPJS Claim Duration Claim File Completeness Diagnosis Coding Accuracy Medical Record Ordinal Logistic Regression