Exploring the implications of national health insurance claim disputes for hospital cash flow in the fourth quarter: A qualitative study in Indonesia
DOI: https://doi.org/10.33024/min.v9i8.4368
BPJS Kesehatan Cash Flow Claim Dispute Claim Verification Hospital
Abstract
Background: Claim disputes within Indonesia’s National Health Insurance (JKN) system, administered by BPJS Kesehatan, represent a significant challenge in the healthcare reimbursement process. Unresolved or disputed claims may delay reimbursement to hospitals, potentially disrupting cash flow and affecting their financial stability.
Purpose: To analyze the impact of BPJS Kesehatan claim disputes on the cash flow of Hospital X during the fourth quarter of 2025.
Method: A qualitative descriptive case study was conducted. Data were collected through in-depth semi-structured interviews with two key informants, a hospital claim verifier and a finance officer, supplemented by a review of BAHV documents and claim dispute recapitulation records for the fourth quarter of 2025. Data were analyzed using the Miles and Huberman interactive model, comprising data reduction, data display, and conclusion drawing and verification.
Results: A total of 871 disputed claims valued at IDR 5,474,454,400 were identified. The disputes involved medical factors requiring further verification, discrepancies in diagnosis and procedure coding, and incomplete supporting documentation. Delays in resolving disputed claims were associated with delayed reimbursement and cash inflows, reduced availability of funds for hospital operations, and increased pressure on short-term liquidity.
Conclusion: BPJS Kesehatan claim disputes affected hospital cash flow through delays in reimbursement and reduced availability of operational funds. Strengthening internal claim verification, coding accuracy, documentation completeness, and coordination among relevant units may help reduce claim disputes and support stable hospital cash flow.
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