The number of patients that using National Health Insuranceor usually known as JaminanKesehatan Nasional (JKN) areincreasing every year. However, the increasement at RS PKU Muhammadiyah Yogyakarta was not accompanied by an increase in income due to pending claims and missing claim documents.The purpose of this study was to determine the BPJS Health claims model at RS PKU Muhammadiyah Yogyakarta. This study uses qualitative methods with in-depth interviews.From the research results obtained factors that cause pending claims are incomplete medical resume, doctor's writing is difficult to read, incomplete supporting documents, diagnosis without therapy, a differences between the coding officers and BPJS Health verifiers, administrative mismatches, collateral in traffic accident and accident cases work, BPJS Health shifting regulation, while the cause of lost claim documents is due to HR factors.The conclusion is the current system is not functioning well