Scribd Logo
Upload

Welcome to Scribd!

  • 26 views

    BPJS Kesehatan Cab. PASURUAN: Umpan Balik Verifikasi Pengajuan Klaim Tingkat Pertama

    Uploaded by

    Fivtakhul Khoiria
    The document is a verification report from BPJS Kesehatan Cab. PASURUAN for claim submissions from Provider Gadingrejo for the month of November 2020. It details 67 valid patient claims totaling Rp. 1,870,000 that were approved for payment, with no pending or disputed claims. One claim for Rp. 100,000 was deemed invalid due to the patient having an IUD implant in September 2019 that was not recorded as being removed.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd

    BPJS Kesehatan Cab. PASURUAN: Umpan Balik Verifikasi Pengajuan Klaim Tingkat Pertama

    Uploaded by

    Fivtakhul Khoiria
    26 views3 pages
    The document is a verification report from BPJS Kesehatan Cab. PASURUAN for claim submissions from Provider Gadingrejo for the month of November 2020. It details 67 valid patient claims totaling Rp. 1,870,000 that were approved for payment, with no pending or disputed claims. One claim for Rp. 100,000 was deemed invalid due to the patient having an IUD implant in September 2019 that was not recorded as being removed.

    Original Title

    CreatePDF (1)

    Copyright

    © © All Rights Reserved

    Available Formats

    DOCX, PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    The document is a verification report from BPJS Kesehatan Cab. PASURUAN for claim submissions from Provider Gadingrejo for the month of November 2020. It details 67 valid patient claims totaling Rp. 1,870,000 that were approved for payment, with no pending or disputed claims. One claim for Rp. 100,000 was deemed invalid due to the patient having an IUD implant in September 2019 that was not recorded as being removed.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    26 views3 pages

    BPJS Kesehatan Cab. PASURUAN: Umpan Balik Verifikasi Pengajuan Klaim Tingkat Pertama

    Uploaded by

    Fivtakhul Khoiria
    The document is a verification report from BPJS Kesehatan Cab. PASURUAN for claim submissions from Provider Gadingrejo for the month of November 2020. It details 67 valid patient claims totaling Rp. 1,870,000 that were approved for payment, with no pending or disputed claims. One claim for Rp. 100,000 was deemed invalid due to the patient having an IUD implant in September 2019 that was not recorded as being removed.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    of 3

    BPJS Kesehatan Cab.

    PASURUAN
    UMPAN BALIK VERIFIKASI
    PENGAJUAN KLAIM TINGKAT PERTAMA

    Nomor FPK : P2011000029809

    Provider : Gadingrejo

    Bulan Pelayanan : November 2020

    Pelayanan : RJTP

    Pelayanan Verifikasi

    Total Data : 68 Total Data : 67 Layak : 67 Tidak Layak : 1

    Total Tagihan : Rp. 1.970.000 Total Tagihan : Rp. 1.870.000 Pending : 0 DIspute :0

    NO TRANSAKSI NAMA PESERTA TGL MASUK TGL PULANG BIAYA STAT KETERANGAN

    RODIYATUL KHASANAH
    132503011120Y000031 02/11/2020 02/11/2020 Rp. 15.000 Layak
    (0002462453122)

    132503011120Y000045 NILA DEVIANA (0000784955665) 02/11/2020 02/11/2020 Rp. 15.000 Layak

    132503011120Y000048 SAIFUDAYANTI (0000785544412) 02/11/2020 02/11/2020 Rp. 15.000 Layak

    132503011120Y000050 FARIDA (0000786137319) 02/11/2020 02/11/2020 Rp. 15.000 Layak

    132503011120Y000114 RENI AGUS SULISTIANI (0002899551014) 03/11/2020 03/11/2020 Rp. 15.000 Layak

    132503011120Y000183 SULAMI (0001049667311) 04/11/2020 04/11/2020 Rp. 15.000 Layak

    132503011120Y000185 MIFTAKHUL JANNAH (0000785586655) 04/11/2020 04/11/2020 Rp. 100.000 Layak

    132503011120Y000217 KURNIA (0002416023911) 05/11/2020 05/11/2020 Rp. 15.000 Layak

    132503011120Y000267 ANISAH (0001716876156) 07/11/2020 07/11/2020 Rp. 15.000 Layak

    EMILDA FAUZIATUL UMROH


    132503011120Y000271 07/11/2020 07/11/2020 Rp. 15.000 Layak
    (0000785442846)

    132503011120Y000295 ANI (0001908351538) 07/11/2020 07/11/2020 Rp. 15.000 Layak

    132503011120Y000312 QOSIDAH (0000785826371) 09/11/2020 09/11/2020 Rp. 15.000 Layak

    ANGGI MALINI RACHMA SEFFIDIA


    132503011120Y000399 07/11/2020 07/11/2020 Rp. 15.000 Layak
    (0000784576787)

    132503011120Y000407 SOFEYAH (0002177630583) 10/11/2020 10/11/2020 Rp. 15.000 Layak

    132503011120Y000415 MAISAROH (0000717601689) 10/11/2020 10/11/2020 Rp. 100.000 Layak

    132503011120Y000439 MIA AMBARWATI (0002159736592) 06/11/2020 06/11/2020 Rp. 15.000 Layak

    132503011120Y000484 SITI AISAH (0000720987838) 11/11/2020 11/11/2020 Rp. 15.000 Layak

    132503011120Y000486 ZUNDAH (0002416037308) 11/11/2020 11/11/2020 Rp. 15.000 Layak

    132503011120Y000501 SITI JUMA'IYAH (0002814657636) 11/11/2020 11/11/2020 Rp. 15.000 Layak

    132503011120Y000514 IDA RAKHMAWATI (0002416040728) 09/11/2020 09/11/2020 Rp. 100.000 Layak

    132503011120Y000518 TIKASARI (0002415973691) 11/11/2020 11/11/2020 Rp. 15.000 Layak

    132503011120Y000526 SITI ASIYAH (0000785354589) 12/11/2020 12/11/2020 Rp. 15.000 Layak

    132503011120Y000620 ROKHMAH (0002159728367) 13/11/2020 13/11/2020 Rp. 15.000 Layak

    132503011120Y000621 SITI SOLICHA (0001974588772) 13/11/2020 13/11/2020 Rp. 15.000 Layak

    132503011120Y000674 ROBIKATUL ADAWIYAH (0001432660239) 14/11/2020 14/11/2020 Rp. 15.000 Layak

    132503011120Y000675 NUR KHASANAH (0000786073206) 14/11/2020 14/11/2020 Rp. 15.000 Layak

    132503011120Y000676 WAHYUNI (0000786140256) 14/11/2020 14/11/2020 Rp. 15.000 Layak

    132503011120Y000700 CHOLILAH (0002416242688) 16/11/2020 16/11/2020 Rp. 15.000 Layak

    132503011120Y000790 ROBIATUL ADAWIYA (0000785311863) 17/11/2020 17/11/2020 Rp. 15.000 Layak


    NO TRANSAKSI NAMA PESERTA TGL MASUK TGL PULANG BIAYA STAT KETERANGAN

    132503011120Y000791 MARIYANAH (0002750700756) 17/11/2020 17/11/2020 Rp. 15.000 Layak

    132503011120Y000824 KHOIRIYAH (0000785305192) 17/11/2020 17/11/2020 Rp. 15.000 Layak

    132503011120Y000825 ANIS (0002413774045) 17/11/2020 17/11/2020 Rp. 100.000 Layak

    132503011120Y000840 HARIYATI (0002044026011) 18/11/2020 18/11/2020 Rp. 15.000 Layak

    132503011120Y000842 FITRIYANI (0000785540013) 18/11/2020 18/11/2020 Rp. 15.000 Layak

    132503011120Y000843 DIAH RULIANA SAFITRI (0002415967817) 18/11/2020 18/11/2020 Rp. 15.000 Layak

    132503011120Y000857 FATMAWATI (0000786138175) 18/11/2020 18/11/2020 Rp. 15.000 Layak

    132503011120Y000859 NUR DHUCHA (0002416028848) 18/11/2020 18/11/2020 Rp. 15.000 Layak

    132503011120Y000869 SETIYARINI (0000786725537) 18/11/2020 18/11/2020 Rp. 15.000 Layak

    132503011120Y000884 PERMANA LESTARI (0002416028308) 18/11/2020 18/11/2020 Rp. 15.000 Layak

    132503011120Y000982 MUNAWAROH (0002731575543) 20/11/2020 20/11/2020 Rp. 100.000 Layak

    132503011120Y001002 NURUL HUDA (0000786843696) 20/11/2020 20/11/2020 Rp. 15.000 Layak

    132503011120Y001037 SITI SOFIA (0000785796658) 21/11/2020 21/11/2020 Rp. 15.000 Layak

    132503011120Y001044 FENI IMANIA (0000786100274) 21/11/2020 21/11/2020 Rp. 100.000 Layak

    132503011120Y001050 JAM'IYAH (0002750879272) 21/11/2020 21/11/2020 Rp. 15.000 Layak

    132503011120Y001051 AFIFA (0002749795301) 21/11/2020 21/11/2020 Rp. 15.000 Layak

    132503011120Y001053 KHUSNUL KHOTIMAH (0000786640713) 21/11/2020 21/11/2020 Rp. 115.000 Layak

    132503011120Y001104 LAILATUL RIZKIYAH (0000785359113) 23/11/2020 23/11/2020 Rp. 15.000 Layak

    132503011120Y001138 SITI SUWARNI (0002757581482) 23/11/2020 23/11/2020 Rp. 15.000 Layak

    132503011120Y001147 HELLA KUMALA SARI (0001311693579) 23/11/2020 23/11/2020 Rp. 100.000 Layak

    132503011120Y001150 KHULIYANA (0002814657939) 23/11/2020 23/11/2020 Rp. 15.000 Layak

    132503011120Y001192 NUR ASIYAH (0000786128916) 24/11/2020 24/11/2020 Rp. 15.000 Layak

    132503011120Y001225 NUR WATINI (0001844341751) 24/11/2020 24/11/2020 Rp. 100.000 Layak

    132503011120Y001231 ROHANA PANJAITAN (0000786773035) 24/11/2020 24/11/2020 Rp. 100.000 Layak

    Terdapat riwayat pasang KB


    Tidak
    132503011120Y001317 FITRIA YAMANI THALIB (0001836921925) 10/11/2020 10/11/2020 Rp. 100.000 IUD/Implan pada September 2019
    Layak
    dan belum tercatat lepas KB

    132503011120Y001332 SITI FARIDAH (0000785569421) 25/11/2020 25/11/2020 Rp. 15.000 Layak

    132503011120Y001355 RIRIN (0001321680251) 27/11/2020 27/11/2020 Rp. 15.000 Layak

    SELLA ALFIANA FITRIANI


    132503011120Y001374 27/11/2020 27/11/2020 Rp. 15.000 Layak
    (0000725568647)

    132503011120Y001376 ANIK KOMARIYAH (0002415991307) 26/11/2020 26/11/2020 Rp. 15.000 Layak

    132503011120Y001399 ASIYAH (0000786423868) 28/11/2020 28/11/2020 Rp. 15.000 Layak

    132503011120Y001401 SUYANTI (0000658530988) 28/11/2020 28/11/2020 Rp. 15.000 Layak

    132503011120Y001405 BEDDRIYAH (0002416024271) 28/11/2020 28/11/2020 Rp. 15.000 Layak

    SRI USNAWATI NINGRUM


    132503011120Y001418 28/11/2020 28/11/2020 Rp. 15.000 Layak
    (0002416392999)

    132503011120Y001421 TOIFA (0000785826775) 25/11/2020 25/11/2020 Rp. 15.000 Layak

    132503011120Y001423 JAMIK (0002905671161) 27/11/2020 27/11/2020 Rp. 15.000 Layak

    132503011120Y001491 ENDANG BASUKI (0001049677738) 28/11/2020 28/11/2020 Rp. 15.000 Layak

    132503011120Y001492 SITI ROCHBIYYAH (0000785603068) 28/11/2020 28/11/2020 Rp. 15.000 Layak

    132503011120Y001496 ARISKA APRILIA (0001704241607) 30/11/2020 30/11/2020 Rp. 15.000 Layak

    132503011120Y001514 LILIK SUPRIYANTI (0000785519919) 12/11/2020 12/11/2020 Rp. 15.000 Layak

    Tanggal, 23/01/2021
    Tanggal terima FPK,
    Verifikator Pengaju Klaim

    You might also like