Hasil Pencarian  ::  Simpan CSV :: Kembali

""Understanding Health Insurance, Twelfth Edition, is the essential learning tool you need when preparing for a career in medical insurance billing. This comprehensive and easy-to-understand text is fully updated with the latest code sets and guidelines, and covers important topics in the field like managed care, legal and regulatory issues, coding systems, reimbursement methods, medical necessity, and common health insurance plans. The Twelfth Edition has been updated to include new legislation that affects health care, ICD-10-CM coding, implementing the electronic health record, the Medical Integrity Program (MIP), the medical review process, and more. Practice exercises in each chapter provide plenty of review, and the accompanying workbook provides even more application-based assignments and additional case studies for reinforcement,. Purchase of this text includes access to free online SimClaim CMS-1500 claims completion software and free-trial access to Optum?s EncoderPro.com - Expert encoder software" -- p. [4] of cover."

"Skripsi ini membahas terkait gambaran proses klaim program jaminan kesehatan non JKN pada Unit Pengeolola Jaminan Kesehatan (UP Jamkesjak) Dinas Kesehatan Provinsi DKI Jakarta. Penelitian ini merupakan penelitian kualitatif dengan metode pengumpulan data yaitu wawancara mendalam, telaah dokumen, dan observasi. Hasil penelitian menunjukkan bahwa input Sumber Pendanaan, Standar Operasional Prosedur, Kebijakan dan Sarana Prasarana sudah cukup baik untuk mendukung proses klaim, lalu untuk Sumber Daya Manusia, Sistem Informasi SIJAKA masih kurang dari segi jaringan internet dan sering terjadi error serta kurangnya Kelengkapan Berkas Klaim. Pada bagian proses terdapat masalah yaitu masih ditemukan berkas klaim yang tidak lengkap dan tidak sesuai sehingga hasil verifikasi menjadi pending, selain itu juga masih terdapat masalah saat menerbitkan BAHV seperti salah tanggal, lalu pengumpulan draft BAHV yang mendekati deadline. Pada bagian output sudah cukup tepat dalam pembayaran klaim namun masih ditemukan beberapa keterlambatan yang disebabkan oleh faktor-faktor yaitu ketidaklengkapan berkas klaim yang diajukan oleh Rumah Sakit, kurangnya tenaga verifikator medis, dan aplikasi SIJAKA yang sering error karena jaringan internet. Untuk menanggulangi jaringan internet SIJAKA yang error dibantu oleh tenaga ahli teknologi informasi.

---

This thesis discusses the description of the process of non-JKN health insurance program claims at the Health Insurance Management Unit (UP Jamkesjak) of the DKI Jakarta Provincial Health Office. This research applied qualitative methods, including namely indepth interviews, document review, and observation. The results showed that the inputs of Funding Sources, Standard Operating Procedures, Policies and Infrastructure were good enough to support the claims process, then for Human Resources, the SIJAKA Information System is still lacking in terms of internet network and frequent errors and lack of Completeness of Claim Files. In the process section there are problems, namely finding incomplete and inappropriate claim files so that the verification results are pending, besides that there are also problems at the time of issuance of the BAHV such as the wrong date, then the submission of the BAHV draft is approaching the deadline. The output section is sufficiently precise in paying claims, but there are still some delays caused by factors namely incomplete claim files submitted by the Hospital, lack of medical verifiers, and the SIJAKA application which often has errors due to the internet network. To overcome the error in the SIJAKA internet network, information technology experts assisted."