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Kata kunci: kesesuaian dan ketidak sesuaian, berkas klaim, rawat inap, BPJS Kesehatan
In managing claim documents for the BPJS Kesehatan in Bulungan District hospital, there are some errors have been found that may lead to delays in payment. This study aims to determine how claim administration process among inpatients is implemented and what are managerial bottleneck factors that may cause problem and delay in paymentt in Bulungan district hospital. This case study was using qualitative approach. The inpatient claim documents of BPJS Kesehatan on that period was analyzed to learn any discrepancies. This included factors in the process during medical resume filling, collecting the supporting claim documents, diagnose and procedures coding, and data entry/INA-CBGs grouping. The study revealed that some claim documents were still not appropriately administered in accordance with BPJS Kesehatan claim equired procedures, based on medical resume filling to the data entry/INA-CBGs grouping. Problems were found caused by various factors: number and competence of human resources (man), financial constrained (money), the management policies (method), limited facilities to support e-file and e-process (material), as well as limited resources (machine). Bulungan District Hospital is expected to have a regular monitoring and evaluation for the inpatient claim administration process of BPJS Kesehatan and improve its claim management process
Keywords: conformity and discrepancies, claim documents, inpatient, BPJS Kesehatan
Pemerintah mendorong agar setiap perusahaan melakukan penerapan SMK3 di lingkungan kerja masing-masing. Sesuai dengan Peraturan Pemerintah Republik Indonesia Nomor 50 Tahun 2012. Penerapan K3 sering kali dianggap sebagai cost atau beban biaya bagi perusahaan, bukan investasi untuk mencegah kecelakaan kerja. Menurut data organisasi perburuhan internasional (ILO) sekitar 2,78 juta pekerja meninggal setiap tahun karena kecelakaan kerja dan penyakit akibat kerja. Penelitian bertujuan untuk menganalisis kesesuaian Kinerja SMK3 dan tingkat pemahaman budaya keselamatan karyawan di Perusahaan X. Data Penelitian meliputi data primer dengen FGD menggunakan kuisioner safety culture maturity The Hudson Model dalam 6 kelompok Jabatan dan data sekunder (hasil temuan eksternal audit ISO 45001 : 2018 dan SMK3 sesuai PP No. 50 tahun 2012). Metodelogi penelitian menggunakan deskriptif analitik dan mix metode (semi kuantitatif dan kualitatif). Ada 20 variabel metode Hudson diperoleh tingkat kematangan budaya pada angka 3,33 (kategori Kalkulatif). Ini berarti keselamatan dianggap sebagai tanggung jawab Petugas K3 atau unit K3 saja yang berfokus terhadap pemenuhan standar atau peraturan saja yang menjadi minimum requirement. Tingkat pengukuran kinerja SMK3 perusahaan telah berada di level memuaskan menunjukan bahwa hasil SMK3 Perusahaan mengkonfirmasi apa yang dideteksi tingkat kematangan budaya keselamatan Perusahaan baru mulai untuk pemenuhan standar K3 dan kebutuhan peraturan perundang-undang. Perusahaan belum melakukan improvement ke arah generative yang sesungguhnya untuk menuju level proaktif dan generative tidak bisa hanya berfokus pada kebutuhan SMK3 namun banyak hal yang dibutuhkan improvement. Jika Perusahaan ingin menuju tingkat proaktif keselamatan dan nilai tingkat budaya generative maka keselamatan harus menjadi nilai yang diyakini secara bersama di seluruh organsasi dan unit kerja.
The government encourages every company to implement SMK3 in their respective work environments. In accordance with Republic of Indonesia Government Regulation Number 50 of 2012. Implementing K3 is often considered a cost or burden for companies, not an investment to prevent work accidents. According to data from the International Labor Organization (ILO), around 2.78 million workers die every year due to work accidents and occupational diseases. The research aims to analyze the suitability of SMK3 performance and the level of understanding of employee safety culture at Company in accordance with PP No. 50 of 2012). The research methodology uses analytical descriptive and mixed methods (semi quantitative and qualitative). There are 20 variables in the Hudson method, the level of cultural maturity is 3.33 (Calculative category). This means that safety is considered the responsibility of the K3 Officer or K3 unit which focuses on fulfilling standards or regulations which are the minimum requirements. The level of measurement of the company's SMK3 performance has been at a satisfactory level, indicating that the Company's SMK3 results confirm what was detected. The maturity level of the company's safety culture is just starting to fulfill K3 standards and statutory regulatory requirements. The company has not made improvements in a truly generative direction. In order to reach a proactive and generative level, it cannot only focus on SMK3 needs, but there are many things that need improvement. If the Company wants to move towards a proactive level of safety and a generative cultural value level, then safety must become a value that is shared across the organization and work units. Key words: Conformity, Safety Performance, Safety Culture Maturity Level