THE IMPLICATION OF INCOMPLETE MEDICAL RESUMES ON HEALTHCARE INSURANCE CLAIMS IN INDONESIA: A SYSTEMATIC REVIEW
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Abstract
This research is based on the background of the important role of medical resumes on claims processing of Healthcare Insurance in Indonesia widely known as Healthcare BPJS. The completeness of the medical resume is still a problem as it is not as required in healthcare services. The aims of this research are to review systematically the triggering factors for incomplete medical resumes, and to know the implications of incomplete medical resumes on BPJS claims. This research uses the synthesis grid method with the subjects used are books, literature articles, and internet media related to the implications of incomplete medical resumes on BPJS claims. The results of this research are that there are several factors that trigger the incomplete medical resume, which is dominated by the man factor (no in charge doctor of service/DPJP signature), followed by the machine factor, method, and material factors. Meanwhile, there are several implications of incomplete medical resumes on BPJS claims, namely pending, delay, and returned claim.
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Incomplete, Medical Resume, BPJS Claim