This study attempts to explain the process and mechanism of health service model claim with BPJS facility in private hospitals type C. Object of this study was medical record of BPJS patients at RS PKU Muhammadiyah Gampinghospital. This study was done in RS PKU Muhammadiyah Gamping. Emergency Department services at the hospital include OneDay Care and One Day Care Surgery services. An interesting finding in this study revealed that the verification process of BPJS claims by the verifiers at RS PKU Muhammadiyah Gamping has not run as expected because the verifiers were often not available atthe hospital and lack of similar perceptions among verifiers at RS PKU Muhammadiyah Gamping. The implementation of BPJS claim verification at RS PKU Muhammadiyah Gamping has not run well due to the medical personnel or doctor in charge of patient (DPJP) was incomplete in filling the medical record. The cause of non-compliance with BPJS claims at RS PKU Muhammadiyah Gamping wasthe incompatible codingorgroupingof diagnosis into INA-CBG’s system. This is due to the lack of understanding on medical record at RS PKU Muhammadiyah Gamping that causes differences between INA-CBG’s package with the verifier results of RS PKU Muhammadiyah Gamping.
