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Background: incomplete and late claim submission may result in the delay of claim payment. The impact of late payment will certainly disrupt the cash flow of the hospital. This study aims to evaluate the claim submission and returning for BPJS inpatient services. Methods: this was cross sectional study with a case study design approach. The source of data used was submission and returned claim data from hospital financing department during the period of January to June 2017. The data were analyzed descriptively. Results: the highest frequency for inpatients claim submission was 17 times and the lowest was 13 times. The hospital submit the claim file almost every 2-3 days. Of the 11.945 inpatient claims, as many as 3.013 claim files were returned by BPJS. The total claim amounts of 11,945 files was Rp. 146.967.494.700,and, the total amount of returned claim was Rp. 45.150.888.100,-. The reasons of claim returned including administrative completeness, incomplete summary discharge , confirmation of coding, inappropriate files, unreadable TXT in BPJS application and supporting examination. The most common causes of claim files returned was confirmation of coding (42.4%) and incompleteness of discharge summary (30.3%) Conclusion: the hospital was never late in submitting claim documents but the claim returned by BPJS were still high. The most common causes of claim returned to the hospital was coding confirmation and incompleteness of discharge summary. (Health Science Journal of Indonesia 2019;10(1):27-31)

Evaluation of claim submission and returning for BPJS inpatient services: a case study of hospital X in 2017