Penelitian ini dilatarbelakangi oleh adanya berkas klaim pasien rawat inapBPJS Kesehatan di RSUD Tanah Abang yang terlambat dalam penyelesaianklaim. Adanya penangguhan pembayaran klaim pending pasien JKN sebesarRp154,073,700 oleh BPJS Kesehatan terhadap RSUD Tanah Abang akibat adanyaberkas yang pending, menyebabkan kejadian tunda bayar. Penundaan pembayaranklaim idealnya tidak terjadi apabila berkas klaim dapat dikelola dengan baik.Penelitian ini menggunakan pendekatan kualitatif dengan metode wawancaramendalam, telaah dokumen, dan observasi. Penelitian yang dilaksanakan padabulan Mei-Juni 2018 ini, menemukan bahwa proses pengelolaan berkas klaimsudah baik, namun dalam setiap tahapan proses pengelolaan klaim masih terdapatkekurangan yang terjadi baik dari segi teknis, SDM, sistem informasi, dan saranaprasarana. Saran bagi RSUD Tanah Abang adalah untuk melakukan pengawasandalam proses pengelolaan berkas klaim dan pemenuhan kebutuhan dalam prosespengelolaan berkas klaim.

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Based on I Presidential Regulation number 72 of 2012 states that theNational Health System is a health management organized by all components ofthe Indonesian nation in an integrated and mutually supportive to ensure theachievement of the highest degree of public health as a manifestation of thewelfare of society according to the 1945 Constitution. This research is motivatedby the claim file of inpatient BPJS Kesehatan in RSUD Tanah Abang which is latein the settlement of the claim. The existence of suspension of payment claimspending JKN patients amounting to Rp154,073,700, by BPJS Health to RSUDTanah Abang due to the pending file, causing the delay event. The defaultpayment claim delay does not occur if the claim file can be properly managed.This research uses qualitative approach with in depth interview method,document review, and observation. The research, conducted in May June 2018,found that the claims file management process was good, but in every stage ofclaims management process there were still deficiencies in terms of technical,human resources, information system, and infrastructure. Suggestion for RSUDTanah Abang is to conduct supervision in the process of claim file managementand fulfillment requirement in process of claim file management.