UMPAN BALIK HASIL VERIFIKASI

Nama RS : RS AROFAH

Tingkat Pelayanan : RJTL

Tgl.Pelayanan : 01 April 2014 s/d 30 April 2014

Hal.1/1

No No.SEP Tgl. Verifikasi Biaya

Diajukan Disetujui
1 0196R00704140000001 30/04/2014 163,891 163,891
2 0196R00704140000002 30/04/2014 155,372 155,372
3 0196R00704140000003 30/04/2014 151,488 151,488
4 0196R00704140000004 30/04/2014 132,248 132,248
5 0196R00704140000005 30/04/2014 190,832 190,832
6 0196R00704140000006 30/04/2014 155,372 155,372
7 0196R00704140000007 30/04/2014 155,372 155,372
8 0196R00704140000008 30/04/2014 132,711 132,711
9 0196R00704140000009 30/04/2014 190,832 190,832
10 0196R00704140000010 30/04/2014 132,711 132,711
11 0196R00704140000011 30/04/2014 132,711 132,711
12 0196R00704140000012 30/04/2014 209,644 209,644
13 0196R00704140000015 30/04/2014 155,372 155,372
14 0196R00704140000016 30/04/2014 155,372 155,372
15 0196R00704140000017 30/04/2014 132,711 132,711
16 0196R00704140000018 30/04/2014 155,372 155,372
17 0196R00704140000019 30/04/2014 155,372 155,372
18 0196R00704140000020 30/04/2014 132,711 132,711
19 0196R00704140000021 30/04/2014 155,372 155,372
20 0196R00704140000023 30/04/2014 163,891 163,891
21 0196R00704140000024 30/04/2014 163,891 163,891
22 0196R00704140000025 30/04/2014 163,891 163,891
23 0196R00704140000026 30/04/2014 155,372 155,372
24 0196R00704140000027 30/04/2014 132,711 132,711
25 0196R00704140000028 30/04/2014 155,372 155,372
26 0196R00704140000029 30/04/2014 155,372 155,372
 UMPAN BALIK HASIL VERIFIKASI

Nama RS : RS AROFAH

Tingkat Pelayanan : RJTL

Tgl.Pelayanan : 01 April 2014 s/d 30 April 2014

Hal.1/1

27 0196R00704140000030 30/04/2014 155,372 155,372

28 0196R00704140000031 30/04/2014 132,711 132,711
29 0196R00704140000038 30/04/2014 176,844 176,844
30 0196R00704140000039 30/04/2014 132,711 132,711
31 0196R00704140000041 30/04/2014 155,372 155,372
32 0196R00704140000043 30/04/2014 132,711 132,711
33 0196R00704140000044 30/04/2014 155,372 155,372
34 0196R00704140000045 30/04/2014 190,832 190,832
35 0196R00704140000046 30/04/2014 155,372 155,372
36 0196R00704140000047 30/04/2014 163,891 163,891
37 0196R00704140000048 30/04/2014 132,711 132,711
38 0196R00704140000049 30/04/2014 190,832 190,832
39 0196R00704140000050 30/04/2014 149,429 149,429
40 0196R00704140000051 30/04/2014 132,711 132,711
41 0196R00704140000052 30/04/2014 238,415 238,415
42 0196R00704140000053 30/04/2014 132,711 132,711
43 0196R00704140000054 30/04/2014 132,711 132,711
44 0196R00704140000055 30/04/2014 132,711 132,711
45 0196R00704140000056 30/04/2014 185,538 185,538
46 0196R00704140000057 30/04/2014 176,844 176,844
47 0196R00704140000061 30/04/2014 132,711 132,711
48 0196R00704140000065 30/04/2014 130,640 130,640
49 0196R00704140000066 30/04/2014 185,538 185,538
50 0196R00704140000067 30/04/2014 190,832 190,832
51 0196R00704140000068 30/04/2014 132,711 132,711
52 0196R00704140000069 30/04/2014 130,640 130,640
53 0196R00704140000070 30/04/2014 151,488 151,488
54 0196R00704140000071 30/04/2014 132,711 132,711
 UMPAN BALIK HASIL VERIFIKASI

Nama RS : RS AROFAH

Tingkat Pelayanan : RJTL

Tgl.Pelayanan : 01 April 2014 s/d 30 April 2014

Hal.1/1

55 0196R00704140000081 30/04/2014 163,891 163,891

56 0196R00704140000082 30/04/2014 176,844 176,844
57 0196R00704140000083 30/04/2014 155,372 155,372
58 0196R00704140000084 30/04/2014 163,891 163,891
59 0196R00704140000085 30/04/2014 163,891 163,891
60 0196R00704140000086 30/04/2014 185,538 185,538
61 0196R00704140000087 30/04/2014 185,538 185,538
62 0196R00704140000088 30/04/2014 163,891 163,891
63 0196R00704140000089 30/04/2014 163,891 163,891
64 0196R00704140000090 30/04/2014 190,832 190,832
65 0196R00704140000091 30/04/2014 145,218 145,218
66 0196R00704140000092 30/04/2014 155,372 155,372
67 0196R00704140000093 30/04/2014 132,711 132,711
68 0196R00704140000095 30/04/2014 187,279 187,279
69 0196R00704140000096 30/04/2014 155,372 155,372
70 0196R00704140000097 30/04/2014 132,711 132,711
71 0196R00704140000099 30/04/2014 155,372 155,372
72 0196R00704140000101 30/04/2014 155,372 155,372
73 0196R00704140000102 30/04/2014 130,640 130,640
74 0196R00704140000103 30/04/2014 155,372 155,372
75 0196R00704140000104 30/04/2014 145,218 145,218
76 0196R00704140000105 30/04/2014 155,372 155,372
77 0196R00704140000110 30/04/2014 132,711 132,711
78 0196R00704140000111 30/04/2014 155,372 155,372
79 0196R00704140000112 30/04/2014 155,372 155,372
80 0196R00704140000115 30/04/2014 187,279 187,279
81 0196R00704140000116 30/04/2014 132,711 132,711
82 0196R00704140000117 30/04/2014 149,429 149,429
 UMPAN BALIK HASIL VERIFIKASI

Nama RS : RS AROFAH

Tingkat Pelayanan : RJTL

Tgl.Pelayanan : 01 April 2014 s/d 30 April 2014

Hal.1/1

83 0196R00704140000118 30/04/2014 155,372 155,372

84 0196R00704140000120 30/04/2014 120,168 120,168
85 0196R00704140000126 30/04/2014 193,909 193,909
86 0196R00704140000127 30/04/2014 155,372 155,372
87 0196R00704140000128 30/04/2014 176,844 176,844
88 0196R00704140000129 30/04/2014 185,538 185,538
89 0196R00704140000130 30/04/2014 132,711 132,711
90 0196R00704140000131 30/04/2014 121,865 121,865
91 0196R00704140000132 30/04/2014 190,832 190,832
92 0196R00704140000133 30/04/2014 155,372 155,372
93 0196R00704140000134 30/04/2014 155,372 155,372
94 0196R00704140000135 30/04/2014 190,832 190,832
95 0196R00704140000136 30/04/2014 155,372 155,372
96 0196R00704140000137 30/04/2014 132,711 132,711
97 0196R00704140000138 30/04/2014 155,372 155,372
98 0196R00704140000139 30/04/2014 130,640 130,640
99 0196R00704140000140 30/04/2014 121,865 121,865
100 0196R00704140000141 30/04/2014 151,488 151,488
101 0196R00704140000145 30/04/2014 155,372 155,372
TOTAL 15,748,507 15,748,507

RESUME

Total Bea.Diajukan : 15,748,507

Total Bea.Disetujui : 15,748,507

Menyetujui Mengetahui
Direktur RS BPJS KESEHATAN
 UMPAN BALIK HASIL VERIFIKASI

Nama RS : RS AROFAH

Tingkat Pelayanan : RJTL

Tgl.Pelayanan : 01 April 2014 s/d 30 April 2014

Hal.1/1

dr. H. Soekiran Nur Happy A.P