JAKARTA - The submission of claims from hospitals in North Sumatra Province for the treatment of COVID-19 patients who entered BPJS Health in the period March 2020 to November 2021 reached IDR 5.046 trillion. , 94.71 percent of which have been verified.
"The verification process for IDR4.767 trillion has been completed and IDR279 billion is still in the verification process," he said during a meeting with Commission IX of the DPR at the North Sumatra Health Office, in Medan, Tuesday, November 16, quoted from Antara. 2020 to November 2021 in North Sumatra with the status of pending or "disputed" reaching Rp. 1.994 trillion or 33,868 cases.
"Inappropriate claims reached Rp. 15 billion," she said. Mariamah explained that the types of disputes for COVID-19 treatment claims included identities that did not comply with the provisions, the criteria for COVID-19 insurance participants did not comply with the provisions, laboratory supporting examinations did not comply with the provisions (no swab examination and no there are routine blood checks and x-rays). Then the isolation management is not in accordance with the provisions of the COVID-19 prevention and control guidelines, the claim file is incomplete, the diagnosis of comorbidities, comorbid diagnoses are not in accordance with the provisions, hospitalization outside the isolation room set by the director of the hospital .
"Furthermore, the radiology supporting examination did not comply with the provisions and the claim was not appropriate due to problems with the E-Claim application," said Mariamah. 8,983 cases were declared eligible for claims, 1,350 cases were not eligible for claims and 1,363 cases were asked to revise the claim.
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