<![CDATA[This study investigates the factors contributing to pending claims at Muhammadiyah Lamongan Hospital, focusing on work ability, performance, and work motivation among casemix officers. Conducted from May to July 2023, the research utilizes a descriptive quantitative approach with a sample of 342 pending hospitalization claim files. Findings reveal that code discrepancies, incomplete membership administration, and service discrepancies are the main causes of pending claims. Results show significant relationships between motivation and performance, ability and motivation, and performance and work ability of casemix officers, influencing pending claims occurrence. Lack of training and mismatches between job requirements and qualifications also contribute. The study underscores the importance of monitoring and evaluation, standard operating procedures (SOPs), and continuous training for casemix officers to mitigate pending claims, thereby enhancing the efficiency of health care services. Hightligh: 1. Main Causes: Code discrepancies, incomplete administration, and service discrepancies.2. Key Relationships: Motivation, performance, ability affect pending claims occurrence.3. Implications: Monitoring, standard procedures, and training improve health care efficiency. Keywords: pending claims, casemix officers, Muhammadiyah Lamongan Hospital, health care management, quantitative research]]>
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