Claim Submission Research Articles

Revisiting the Compensation Submission Framework for Terrorism Victims: An Analysis of Constitutional Court Decision No. 103/PUU-XXI/2023

Ideally, human rights guarantee protection for every citizen who suffers physical, psychological, or material losses due to unlawful acts or criminal offenses, as stipulated in Articles 28A to 28J of the 1945 Constitution of the Republic of Indonesia (UUD 1945). This protection, including for terrorism victims, should ensure legal certainty in the submission of compensation claims. However, in reality, the absence of a time limit for submitting compensation leads to legal uncertainty for both victims and the state. This research focuses on how legal uncertainty in the submission of compensation for terrorism victims can be addressed through Constitutional Court Decision No. 103/PUU-XXI/2023. The study employs a normative legal research method, where law is understood as written norms within statutory regulations and serves as a benchmark for human behavior deemed appropriate. The findings reveal that Constitutional Court Decision No. 103/PUU-XXI/2023 represents a significant milestone in resolving legal uncertainties related to compensation claims by terrorism victims. However, the recovery process for victims’ trauma often requires more time than initially anticipated.

Court costs as an element of the mechanism of ensuring access to justice

The right of access to justice is considered as an international standard for judicial protection of rights, along with the ways in which court costs can be used for regulatory purposes. The article explores the role of court costs as a critical element in the mechanism for ensuring access to justice, a fundamental principle of democratic societies. Access to justice is a cornerstone of the rule of law, guaranteeing individuals the ability to protect their rights and interests through legal mechanisms. However, court costs, including filing fees, procedural expenses, and other associated charges, often create barriers that limit equal access to the judicial system, particularly for economically disadvantaged individuals. Authors highlight the multifaceted nature of court costs, emphasizing their dual role: on the one hand, they are essential for maintaining the financial sustainability of judicial systems; on the other, they can impede individuals' ability to seek justice. Special attention is given to mechanisms for mitigating the negative impact of court costs, such as exemptions, reductions, and state-funded legal aid. The study also addresses the procedural abuses that can increase court costs unnecessarily, such as the submission of frivolous claims or motions by parties to delay proceedings. The article proposes practical recommendations for optimizing the system of court costs, ensuring their transparency and fairness while balancing the financial needs of the judicial system with the principle of access to justice. These recommendations include improving legislative frameworks, introducing clear criteria for cost exemptions, and enhancing public awareness about available financial support mechanisms.

ANALISIS EFEKTIVITAS PENGELOLAAN DIVISI YAN HC SURABAYA TERHADAP PENGAJUAN REIMBURSEMENT KARYAWAN DAN PENSIUNAN

PT PLN (Persero) as a State-Owned Enterprise (SOE) engaged in the electricity sector has a strong commitment in maintaining the welfare of employees, retirees, and their families through health insurance facilities. This study aims to evaluate the effectiveness of reimbursement claim management at PT PLN (Persero) and identify obstacles in the claim submission process. The research method used is qualitative by collecting data through interviews and observations. Respondents consisted of several Yan HC employees responsible for health claims. The results showed that the claim procedures established by Yan HC are quite effective, but there are several obstacles that require improvement to increase effectiveness and efficiency as well as employee, retiree, and family satisfaction. Keywords: PT PLN (Persero), Reimbursement, Yan HC, Health Facilities, Effectiveness

Case Analysis of Compensation Audit by BPJS in Hospital X Year 2023

Audit Compensation Audits cause operational activities and hospital financial systems to become disrupted and unstable. Based on a preliminary survey at the Hospital, this research aims to analyze Compensation Audit cases carried out by health insurance providers in 2023. The type of research used is Mixed Method, namely a research approach that combines or links qualitative and quantitative forms. This research was conducted in January – June 2024. The research population was 5 compensation audit cases in 2023. In-depth analysis was carried out on 5 compensation audit cases based on analysis of medical resumes, related regulations and based on ICD-10 and ICD-9-CM coding rules. Compensation Audit Case Solution, namely coders must understand medical records, claim submission documents, ICD-10, ICD-9 CM coding rules, BPJS and hospital PPK claims regulations, doctors need to provide clear, specific management and be able to know the patient's condition. treatment class from the start of admission and the health insurance verifier must have the same perception as the previous verifier and be careful in reading and analyzing claim submission documents.

Tinjauan Atas Prosedur Pengajuan Hingga Pembayaran Klaim Asuransi Kendaraan Bermotor

The development of the number of vehicles is inseparable from the risk of uncertainty that lurks. Therefore, motor vehicle insurance is present as a place to transfer risk from unexpected things that happen to vehicles, or to parties included in the policy. The accounting information system exists because of the need to monitor business activities. In submitting an insurance claim, a procedure is needed regarding the claim submission flow to facilitate the company and monitor the company's performance. The purpose of this review is to determine the application of the system in the procedure for submitting to paying JP-Astor claims. This research was conducted by the author at PT. Asuransi Jasaraharja Putera Bogor Marketing Office located at Jl. Re. Martadinata Komp. Ruko Sentra Air Mancur No. 2h, Bogor Tengah, Bogor City. The results of the review indicate that PT Asuransi Jasaraharja Putera Bogor Marketing Office has been quite good at carrying out the procedure for submitting to paying JP-Astor claims. The claim submission and claim payment system at Jasaraharja Putera Bogor Marketing Office has helped the work of employees and insured parties, so that they know the extent of the claim process that has been submitted. Accounting Information System implemented through Care System helps companies in registering and remote authorization. Keywords: Submission, Payment, Claim, Motor Vehicle

Legal Protection for Workers on Job Loss Guarantee in the Tourism Sector

In Indonesia, labo u r social security is a right of workers, as exemplified by the provision of job loss insurance . In essence, social security is designed to ensure that workers retain a decent standard of living in the event of job loss. One of the most frequently demanded rights of workers is the right to social security. The Indonesian Social Security Administration Body (BPJS) programme comprises two distinct categories: social security for health and social security for employment . The following ques tion is posed: How is the job loss insurance programme in the tourism sector implemented at BPJS Ketenagakerjaan Cabang Bali Gianyar ? Furthermore, what form of legal protection is afforded to workers who lose their jobs in accordance with Indonesian Govern ment Regulation No. 37/2021 on the implementation of the Job Loss Insurance Program? Methodology: empirical research employing a soc iological approach. The findings indicate that the implementation of the job loss guarantee programme at BPJS Ketenagakerjaa n Gianyar is conducted in accordance with the submission of job loss insurance claims from workers who have been laid off. At PT CH B Villa, 26 workers who experienced layoffs were eligible to receive the benefits of job loss insurance , including 24 worker s (92%) who were entitled to receive them and two workers (8%) who were not. In conclusion, the implementation of the job loss insur ance programme at the Villa of PT CHB Gianyar has been effective in providing legal protection and benefits for laid off wo rkers. In the event that an employer violates the rights of a dismissed worker, the employer may be subject to administrative sancti ons in accordance with the provisions of Article 46 of Indonesi an Government Regulation No. 37/ 2021 concerning the implement ation of the job loss insurance . These sanctions may include written warnings to the employer and the cessation of certain public se rvices.

Socio-legal instabilities in Ukraine’s wartime Compensation Law for damaged and destroyed residential property

AbstractLaws seeking to resolve war-related problems face a significant dilemma. While the legal establishment in a war-affected country drafts laws based on normative approaches suited to peacetime and stable settings, the civilian population pursues crises livelihoods that are markedly unsuited to compliance with or use of such laws. What emerges are socio-legal instabilities that aggravate instead of resolve wartime problems. With a socio-legal examination of Ukraine’s wartime housing Compensation Law, this article describes six sets of instabilities that compromise the utility of the law and aggravate or create additional problems: (1) the case-by-case approach, (2) administrative and institutional capacities, (3) legal vs. available evidence, (4) the timeframe for claims submission and awareness raising, (5) excluded segments of civil society and (6) prohibitions on selling properties. Approaches from international best practice that may be able to attend to these instabilities are then suggested.

Fraud in genetic testing: Swindling the system

Health care fraud comprises a sizable portion of United States health care expenditure and inflicts undue burden on payors, patients, and the health care system overall. The genetic testing industry is rapidly growing, which propagates opportunities for health care fraud. Although federal organizations have highlighted it as an issue, there is limited research exploring genetic testing fraud. A retrospective review of federal websites, news articles, and a legal database resulted in 42 cases of fraud involving outpatient genetic testing published between February 2019 and December 2023. These cases were analyzed for themes via inductive conventional content analysis. Themes of fraudulent activity included submission of fraudulent claims, kickback or bribe payments, minimal or no contact with patients for whom testing was ordered, inappropriate billing and documentation practices, and further actions to conceal fraud. Repercussions imposed on defendants included monetary penalty, imprisonment, business restrictions, and seizure of property. High rates of medically inappropriate testing in fraud cases highlight the value of genetics experts in ordering or reviewing claims for genetic testing. Examining fraudulent activity in genetic testing can help providers identify and report fraud and provide awareness of optimal health care allocation in the genetic testing industry.

Health benefits and risks of fermented foods-the PIMENTO initiative.

Worldwide, fermented foods (FF) are recognized as healthy and safe. Despite the rapid increase of research papers, there is a lack of systematic evaluation of the health benefits and risks of FF. The COST Action CA20128 "Promoting innovation of fermented foods" (PIMENTO) aims to provide a comprehensive assessment on the available evidence by compiling a set of 16 reviews. Seven reviews will cover clinical and biological endpoints associated with major health indicators across several organ systems, including the cardiovascular, gastrointestinal, neurological, immune, and skeletal systems. Nine reviews will address broader biological questions associated with FF including bioactive compounds and vitamin production, nutrient bioavailability and bioaccessibility, the role of FF in healthy diets and personalized nutrition, food safety, regulatory practices, and finally, the health properties of novel and ethnic FF. For each outcome assessed in the reviews, an innovative approach will be adopted based on EFSA's published guidance for health claim submissions. In particular, each review will be composed of three parts: (1) a systematic review of available human studies; (2) a non-systematic review of the mechanism of action related to the clinical endpoints measured by the human studies identified in part 1; and (3) a non-systematic review of the characterization of the FF investigated in the human studies identified in part 1. The evidence and research gaps derived from the reviews will be summarized and published in the form of a strategic road map that will pave the way for future research on FF.

Revenue Cycle Management: The Art and the Science.

Simply working hard is not enough to maintain a profitable clinical practice. Prompt and complete payment for services is just as critical. Revenue cycle management (RCM) tracks the payment process from patient scheduling through treatment, coding, billing, and reimbursement. Even though reimbursement rates for service codes are preset, and the service is documented, this apparently straightforward process is complicated by insurance payors, negotiated contracts, coding requirements, compliance regulators, and an ever-changing reimbursement environment. Not typically trained in RCM, physicians struggle with its demands of timeliness, accuracy, paperwork, and the constant scrutiny for underpayment or unfulfilled reimbursements. Consequently, they often relent to the pressures and simply accept the decreased reimbursements as "cost of doing business" or else relegate RCM to others on the team. In either case, they leave significant amounts of money on the table. Using published work in health care and other allied sectors, we present a systematic method to understand and improve RCM processes. It also creates a strong partnership between clinicians and their administrative counterparts. Optimizing RCM improves patient experience, reduces the time between submission of claims and payment, eliminates fraud at both the coding and patient levels, and increases cash flow, all of which create a financially stable clinical practice.

Tinjauan Penyebab Klaim Pending Pasien Badan Penyelenggara Jaminan Sosial (BPJS) Rawat Inap di RSUD Kembangan Jakarta Barat

Financing activities at Kembangan Regional Hospital are dominated by BPJS Health Participants, when submitting claim from patients participating in BPJS Health, there are still delays in submitting claim which will have an impact on hospital operational activities. The aim of this research was to determine the causes of Pending Claims that accurred at Kembangan Regional Hospital. This study used a descriptive method with a mix method approach. The BPJS Health claim procedure for inpatient services at Kembangan Hospital is in accordance with the exiting Standar Operating Procedures. The data used are pending claim files originating from inpatient treatment in November 2022- Jaunary 2023. The research result found 941 inpatient claim files and 84 pending claim files. The cause of pending claim were classified into 7, Conformity between surgical procedures was 22 (26%), inaccuracy in administrative verification and SEP suitability in inputting data into INA-CBGs was 19 (23%), coding determined by the coder was not unbundled by 17 (20%), INA-CBG codes was 9 (!1%), DPJP daognostic code matching 6 (7%), Hospital code conformity 6 (7%), and finally redmissions for the same disease coding 5 (6%). Based on the 5M identification, there are factors, namely the man factor: because the claim file was not accepted by BPJS Health due to coding. The coding given by the hospital to the hospital to the BPJS was not appropriate. Material: supporting files which arrived late on the specified day. Meanwhille, the 3 other factors, namely the money machine and methid, were not obstacles or causes fot the return of the claim files. It is recommended to reevaluate and socialize the reasoms fpr returning BPJS Health claims so that the BPJS Health claim submission process is carried out well and accepted.

Limitation of Actions and Air Passenger Rights in Thailand: Importing the Law but Leaving Judicial Reasoning Behind

This article comparatively analyses limitations regarding the submission of passenger claims in Thailand and the EU. Thailand transposed EU Regulation 261/2004 on denied boarding, delay and cancellation of flights into its national law. Since EU Regulation 261/2004 does not contain any provision referring to a statute of limitations for legal actions, the Court of Justice of the European Union (CJEU) found that the limitation period was governed, and continues to be governed, by the domestic law of each Member State, as opposed to the Montreal Convention of 1999 which prescribes a single standard for limitation period. Despite importing this piece of secondary EU legislation, the Thai judicial branch has, so far, not followed the said CJEU judgment. The Thai court selected the two-year limitation period under its domestic law which implemented the Montreal Convention of 1999. Since this lack of harmonization does not benefit the orderly development of international civil aviation, this author suggests that the International Civil Aviation Organization (ICAO) should take action. Limitation of Actions, Air Passenger Rights, Thailand, Denied Boarding, Time Bar

A Position Analysis of BPJS Claims Administration Officers and Verifiers (Case Study: Jambi Province Regional Mental Hospital)

The high coverage rate of handling partially rejected claim financing reaching 7.34% of the total 19,476 cases in the Outpatient Unit of the Jambi Provincial Mental Hospital (RSJD) in 2022, is closely related to the quality of human resources (HR) in this case, the claims officer and the suitability of what is done with the job description, job specifications and standard operating procedures (SOP) that have been made. This study aimed to analyze the position of administrative officers and claim verifiers in the outpatient unit of the Jambi Provincial Mental Hospital. This research used a qualitative method. Information was collected through in-depth interviews with eight informants, observation, and document review. Test validity by triangulating sources, techniques, and data. The results showed that officers already knew the claims administration and verification procedures. The claim administration SOP in this case, the RJTL claim submission SOP and the monthly reporting SOP have not been outlined in a decision letter for the coding SOP. However, it has been outlined in a decision letter but has not been adequately socialized to the officers concerned. The SOP for claim verification has not been outlined in a decision letter and still refers to the technical guidelines for claim verification issued by BPJS Health. It is still found that the delegation of tasks and the number of verification officers not following the calculation of workload and standards set are obstacles in implementing administration and verification of claims in the Jambi Province RSJD outpatient department.

Perbandingan Metode Double Exponential Smoothing dan Triple Exponential Smoothing untuk Menganalisis Klaim Asuransi Pada Masa Pandemi Covid-19 (Studi Kasus: Klaim Asuransi PT. BNI Life Insurance Jakarta Tahun 2017 - 2022)

Covid-19, which has become a global pandemic, has had an adverse impact on various industrial sectors. One of them is the insurance industry. During the Covid-19 pandemic, the submission of Health and Life insurance claims increased significantly. Insurance companies need to make maximum preparations. Thus, it is very important for insurance companies to know how the condition of submitting claims was before and during the Covid-19 pandemic. Not only that, but insurance companies also need to know how to submit claims in the next several periods. To find out this, it is necessary to carry out an analysis, namely forecasting analysis. Based on the cases being investigated, the existing claim data shows trend and seasonal patterns. So that the proper forecasting analysis used is Double Exponential Smoothing and Triple Exponential Smoothing. Then, based on research on this case, the Covid-19 pandemic has had an impact on insurance claims since June 2020

Perlindungan Hukum Terhadap Investor Dalam Investasi Ilegal Akibat Promosi Media Online Influencer Melalui Akun Youtube

The use of social media in online investment activities should ideally provide convenience to the public for investing their assets. The prevalence of online investments within the community does not rule out the possibility that some of them are illegal or unauthorized investments, leading to losses for citizen. Legal protection can be provided to investors namely domains of illegal futures brokerage companies, cessation of illegal futures trading promotion, monitoring and observation of illegal futures trading sites by the regulatory authority. However, there are no explicit rules regarding penalties for influencers promoting binary option trading due to the lack of clear regulations about binary options. The research questions addressed in this study are: What is legal protection to investors in illegal investments YouTube? What is the function of BAPPEBT) to prevent illegal investments due to online influencer promotions YouTube? This research uses the normative juridical. The Conclusion of the research are BAPPEBTI offers preventive protection to the public by continually monitoring and educating about investment procedures in line with regulations. BAPPEBTI can block illegal sites based on regulation, but it can’t prohibit binary option trading due to the persistent emergence of domain sites. Contradictory regulations regarding the submission of claims for Restitution and Compensation result in investors lacking legal protection. BAPPEBTI’s role involves ongoing efforts in monitoring, observation, blocking illegal investment websites, education, and public awareness campaigns. BAPPEBTI is also part of the anti investment scam task force to halt investment solicitation and remove content related to Quotex and binary options.

Analysis of Causes of Inpatient Medical Records Delayed Retrieval at Muna Anggita Hospital Bojonegoro, Indonesia

The delayed retrieval (return) of medical records at Muna Anggita Hospital Bojonegoro in January-May 2022 hindered the data process, reporting, and BPJS claim submissions. It also impeded services when patients underwent health check-ups and affected the quality of hospitals and patient satisfaction. This study aims to analyze the factors causing the tardy return of inpatient medical records based on Lawrence Green's behavior theory, which includes predisposing, enabling, and reinforcing factors. This qualitative study collected data through interviews, observations, documentation, USG (Urgency Seriousness and Growth), and brainstorming. The research subjects include one medical record head, two assembling officers, and four inpatient ward heads. The results indicated that predisposing factors included the lack of knowledge of ward heads and their attitude (behavior) towards extending the return time of medical records. These predisposing factors can occur due to the lack of supporting facilities. Also, motivating external factors such as rewards or reprimands from ward heads and minimal socialization of standard operating procedures (SOPs) regarding borrowing and return of medical records also contribute to the delay. Behavioral factors refer to the ward heads' lack of compliance and discipline in returning medical records. Muna Anggita Hospital should conduct SOP socialization every three months and regularly provide supporting facilities. The ward heads should also set an example regarding medical record return punctuality. The subsequent researchers are encouraged to formulate a strategic plan to reduce the delays in returning inpatient medical records at Muna Anggita Hospital in Bojonegoro.

Optimizing Goods Claims Processing Time in Logistics Operations Through Website-Based Applications with the DMAIC Approach

PT XYZ is an e-commerce company which offers an electronic buying and selling platform for a wide variety of products from many sellers to buyers. As an industry engaged in the commercial sector, logistics has a vital role in shipping goods from upstream to downstream to meet consumer desires. However, conditions in the field are not always in accordance with the plans. Lost or damaged goods during delivery or at the Warehouse are a frequent problem. PT XYZ, through its XYZ Logistics team, implements a claims system for replacing items lost or damaged during the operational process. Currently, the claim submission system is done manually via email. This manual claim system creates many problems due to the lack of proper coordination between stakeholders. Therefore, this study proposed a solution with a lean six sigma approach using the DMAIC (Define, Measure, Analyze, Improve and Control) method. The solution offered to improve PT XYZ's claim system is to design an automated claim system using a website-based application. After implementing a website-based application to automate the XYZ logistics claim process, it was proved that the company was able to reduce lead time by up to 60% from initial conditions, up to 33% of stakeholder workload, and improve data security and real-time supervision.

Claims for the Rights of Third Parties in Good Faith Against Confiscation of Goods in Corruption Criminal Decisions

The judge has the authority to impose additional criminal decisions in criminal acts of corruption in the form of confiscation of goods belonging to third parties in good faith. Article 19 Paragraph (2) of the Anti-Corruption Law states that third parties who have good intentions can claim their rights (object) to the confiscation of goods in a corruption crime decision no later than 2 (two) months after the court decision is pronounced in a hearing open to the public. However, the Corruption Law does not clearly regulate how to submit and examine objections so that in practice there are differences in interpretation by the applicant, respondent and judge in submissions and examinations at trial, so that there is no guarantee of unity and certainty in the legal application of rights claims (objections) to confiscation of goods in the decision of criminal acts of corruption. The legal problem that arises is what are the regulations regarding the submission and examination of claims (objections) of third parties who have good intentions regarding the confiscation of goods in the decision of a criminal act of corruption? Regulations regarding the submission and examination of claims for the rights of third parties in good faith regarding the confiscation of goods in decisions regarding criminal acts of corruption, including the legal position of the parties, method and time of submission, authority to adjudicate, evidence, and legal remedies and implementation of the decision.

Tinjauan Penyebab Pengembalian Berkas Klaim Biaya Pelayanan Pasien Rawat Inap BPJS Kesehatan di Rumah Sakit Pelabuhan Jakarta Tahun 2022

In the process of submitting a BPJS Health Claim, some requirements must be completed by the Health Facility. Of these requirements, the BPJS Health party will know that the claim submission can be paid or returned/delayed. This research was conducted to find out the reasons for returning the claim file for BPJS Kesehatan inpatient care at the Jakarta Harbor Hospital in 2022. The method in this study used descriptive research with a quantitative approach. The results of the study were 118 samples (6.7%) of 1,762 files, the highest returned cause was an inaccuracy in the coding of diagnoses/actions of 49 (42%), and the second highest was not fulfilling inpatient administration 18 (15%), other causes - others as much as 51 (43%). 3 factors from 5M are the cause of returning claim files, namely the human factor: casemix officers who are not diligent, lack of coder understanding/knowledge, and lack of accuracy in the filing department so that files are missed/left behind, machine: there is an upgrade to the latest version of the INA-application CBGs and V-Claim are also the Ministry of Health's newest program which requires TB patients to be inputted into the SITB application, Material: incomplete claim requirements files. While the money and method factors are not an obstacle or a cause for returning claim files. It is recommended to evaluate and re-socialize the reasons for returning BPJS Health claims so that the process of submitting BPJS Health claims is carried out properly and is 100% accepted.

The Relationship between Insurance Participants' Knowledge of Pending Claims: A Study on Insurance Managed by PT. Multiniaga Intermedia Proteksi

The impact of pending claims can affect insurance service activities, becoming hampered and officers' workloads increasing because they have to revise pending claims that are sent. This study aimed to assess the relationship between insurance participants' knowledge of the occurrence of pending claims: a study on insurance managed by PT. Multiniaga Intermedia Proteksi. This study was an observational study of cross-sectional design. A total of 107 research subjects participated in this study. The results of this study show that the claim submission process at PT. Multiniaga Intermedia Proteksi had 107 claims submitted to insurance, and it was known that the results of paid claims submissions were 87 submissions (81.3%), and pending submissions were 20 submissions (18.7%). The results of participants' level of knowledge regarding submitting claims were obtained from 107 respondents. The average value of participants' knowledge was 89.15, with a median of 86.67. The highest value was 86.67. The lowest score obtained by respondents was 60, and the highest score was 100 as the results of knowledge testing on the results of claim status using the t-test, obtained with a probability value (Sig.) 0.196 > 0.1, indicating that knowledge has no significant effect on submitting claims.