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  • Klaim Revisi November II 2016

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    revisi

    Copyright:

    © All Rights Reserved
    Download as XLS, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    9 views22 pages

    Klaim Revisi November II 2016

    Uploaded by

    Ega Jocker
    revisi

    Copyright:

    © All Rights Reserved
    Download as XLS, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    of 22

    KODE_RS KELAS_RS KELAS_RA KODE_TARIPTD ADMISSION_DATDISCHARG BIRTH_DATBIRTH_WE

    2071012 B 3 BS 2 11/1/2016 ### ### 0


    2071012 B 3 BS 2 11/1/2016 ### 2/1/2012 0
    2071012 B 3 BS 2 11/1/2016 ### ### 0
    2071012 B 3 BS 2 11/1/2016 ### 8/1/1966 0
    2071012 B 3 BS 2 11/1/2016 ### 9/5/2009 0
    2071012 B 3 BS 2 11/1/2016 ### 1/5/1972 0
    2071012 B 3 BS 2 11/1/2016 ### ### 0
    2071012 B 3 BS 2 11/1/2016 ### ### 0
    2071012 B 3 BS 2 11/1/2016 ### 3/1/1967 0
    2071012 B 3 BS 2 11/1/2016 ### ### 0
    2071012 B 3 BS 2 11/2/2016 ### ### 0
    2071012 B 3 BS 2 11/2/2016 ### ### 0
    2071012 B 3 BS 2 11/2/2016 ### ### 0
    2071012 B 3 BS 2 11/2/2016 ### ### 0
    2071012 B 3 BS 2 11/3/2016 ### ### 0
    2071012 B 3 BS 2 11/3/2016 ### 9/9/2009 0
    2071012 B 3 BS 2 11/3/2016 ### ### 0
    2071012 B 3 BS 2 11/3/2016 ### ### 0
    2071012 B 3 BS 2 11/4/2016 ### ### 0
    2071012 B 3 BS 2 11/4/2016 ### ### 0
    2071012 B 3 BS 2 11/4/2016 ### ### 0
    2071012 B 3 BS 2 11/7/2016 ### 3/2/1969 0
    2071012 B 3 BS 2 11/7/2016 ### ### 0
    2071012 B 3 BS 2 11/7/2016 ### ### 0
    2071012 B 3 BS 2 11/8/2016 ### ### 0
    2071012 B 3 BS 2 11/8/2016 ### ### 0
    2071012 B 3 BS 2 11/9/2016 ### ### 0
    2071012 B 3 BS 2 11/9/2016 ### ### 0
    2071012 B 3 BS 2 11/10/2016 ### ### 0
    2071012 B 3 BS 2 11/10/2016 ### ### 0
    2071012 B 3 BS 2 11/10/2016 ### ### 0
    2071012 B 3 BS 2 11/10/2016 ### 8/1/1972 0
    2071012 B 3 BS 2 11/10/2016 ### ### 0
    2071012 B 3 BS 2 11/11/2016 ### ### 0
    2071012 B 3 BS 2 11/11/2016 ### 6/1/1985 0
    2071012 B 3 BS 2 11/15/2016 ### ### 0
    2071012 B 3 BS 2 11/15/2016 ### ### 0
    2071012 B 3 BS 2 11/15/2016 ### ### 0
    2071012 B 3 BS 2 11/15/2016 ### ### 0
    2071012 B 3 BS 2 11/15/2016 ### ### 0
    2071012 B 3 BS 2 11/17/2016 ### ### 0
    2071012 B 3 BS 2 11/17/2016 ### ### 0
    2071012 B 3 BS 2 11/18/2016 ### 1/2/2009 0
    2071012 B 3 BS 2 11/18/2016 ### ### 0
    2071012 B 3 BS 2 11/18/2016 ### ### 0
    2071012 B 3 BS 2 11/18/2016 ### ### 0
    2071012 B 3 BS 2 11/18/2016 ### ### 0
    2071012 B 3 BS 2 11/18/2016 ### ### 0
    2071012 B 3 BS 2 11/21/2016 ### ### 0
    2071012 B 3 BS 2 11/21/2016 ### ### 0
    2071012 B 3 BS 2 11/21/2016 ### ### 0
    2071012 B 3 BS 2 11/21/2016 ### ### 0
    2071012 B 3 BS 2 11/21/2016 ### ### 0
    2071012 B 3 BS 2 11/22/2016 ### ### 0
    2071012 B 3 BS 2 11/22/2016 ### ### 0
    2071012 B 3 BS 2 11/22/2016 ### 8/3/1960 0
    2071012 B 3 BS 2 11/23/2016 ### ### 0
    2071012 B 3 BS 2 11/23/2016 ### ### 0
    2071012 B 3 BS 2 11/24/2016 ### 9/1/1992 0
    2071012 B 3 BS 2 11/24/2016 ### ### 0
    2071012 B 3 BS 2 11/24/2016 ### ### 0
    2071012 B 3 BS 2 11/25/2016 ### ### 0
    2071012 B 3 BS 2 11/25/2016 ### ### 0
    2071012 B 3 BS 2 11/25/2016 ### 6/7/1978 0
    2071012 B 3 BS 2 11/25/2016 ### 5/4/1955 0
    2071012 B 3 BS 2 11/25/2016 ### ### 0
    2071012 B 3 BS 2 11/25/2016 ### ### 0
    2071012 B 3 BS 2 11/26/2016 ### ### 0
    2071012 B 3 BS 2 11/28/2016 ### ### 0
    2071012 B 3 BS 2 11/28/2016 ### ### 0
    2071012 B 3 BS 2 11/28/2016 ### 5/2/1986 0
    2071012 B 3 BS 2 11/28/2016 ### 3/2/1986 0
    2071012 B 3 BS 2 11/28/2016 ### ### 0
    2071012 B 3 BS 2 11/29/2016 ### 8/1/1981 0
    2071012 B 3 BS 2 11/29/2016 ### ### 0
    2071012 B 3 BS 2 11/29/2016 ### ### 0
    2071012 B 3 BS 2 11/29/2016 ### ### 0
    2071012 B 3 BS 2 11/30/2016 ### ### 0
    2071012 B 3 BS 2 11/30/2016 ### ### 0
    2071012 B 3 BS 2 11/30/2016 ### ### 0
    2071012 B 3 BS 2 11/30/2016 ### 7/7/1995 0
    2071012 B 3 BS 2 11/30/2016 ### ### 0
    2071012 B 3 BS 2 11/30/2016 ### ### 0
    SEX DISCHARGEDIAGLIST PROCLIST ADL1 ADL2 IN_SP IN_SR IN_SI IN_SD
    2 1 J35.0 31.48 - - None None None None
    2 1 H66.0 31.48 - - None None None None
    1 1 J35.1 31.48 - - None None None None
    1 1 Z09.8;K74. - - - None None None None
    1 1 K03.2 23.09 - - None None None None
    2 1 K04.1 23.71 - - None None None None
    2 1 K04.1 87.12 - - None None None None
    1 1 I86.1 - - - None None None None
    2 1 Z48.8 93.57 - - None None None None
    2 1 Z71.9;G81. - - - None None None None
    1 1 J31.2 31.48 - - None None None None
    2 1 Z09.8;K80. - - - None None None None
    1 1 Z09.8;G40. - - - None None None None
    1 1 Z09.8;I64; - - - None None None None
    2 1 J32.0 31.48 - - None None None None
    1 1 J35.0 31.48 - - None None None None
    2 1 R10.1 - - - None None None None
    2 1 E05.0 - - - None None None None
    2 1 H65.9;J00 31.48 - - None None None None
    2 1 H66.9;J06. 31.48 - - None None None None
    2 1 Z09.8;E05. - - - None None None None
    2 1 R42 31.48 - - None None None None
    2 1 H66.9;J31. 31.48 - - None None None None
    2 1 N03.9 87.44 - - None None None None
    2 1 H65.9;J31. 31.48 - - None None None None
    2 1 Z03.8 31.48 - - None None None None
    2 1 J31.2 31.48 - - None None None None
    2 1 J32.0 31.48 - - None None None None
    1 1 J31.0;J32. 31.48 - - None None None None
    1 1 J35.0 31.48 - - None None None None
    1 1 R10.1 - - - None None None None
    1 1 I95.9;K29. - - - None None None None
    1 1 T15.1 13 - - None None None None
    1 1 Z09.8;I73.9 93.57 - - None None None None
    2 1 J30.4 31.48 - - None None None None
    1 1 J06.8 31.48 - - None None None None
    2 1 J06.9 31.48 - - None None None None
    2 1 J06.8 31.48 - - None None None None
    2 1 J31.0;J32.9 31.48 - - None None None None
    2 1 J31.0;J32. 31.48 - - None None None None
    1 1 J35.0 31.48;90.5 - - None None None None
    2 1 J35.0 31.48 - - None None None None
    1 1 R04.0 31.48 - - None None None None
    2 1 J32.9;J31.0 31.48 - - None None None None
    1 1 H65.9;J00 31.48 - - None None None None
    2 1 J00;J03.9 31.48 - - None None None None
    2 1 Z09.8;M17 93.35;93.1 - - None None None None
    2 1 Z09.8;K66. - - - None None None None
    1 1 J02.9 31.48 - - None None None None
    1 1 J03.9 31.48 - - None None None None
    1 1 J31.0;J03. 31.48 - - None None None None
    2 1 B36.9;H62.96.52;31.4 - - None None None None
    1 1 K04.1 23.71 - - None None None None
    2 1 J31.0;J32.9 31.48 - - None None None None
    1 1 J35.0 31.48;90.5 - - None None None None
    1 1 L80 - - - None None None None
    1 1 T17.3 98.11;31.4 - - None None None None
    1 1 Z09.8;G82. 93.39 - - None None None None
    2 1 H61.2;H60.98.11;31.4 - - None None None None
    1 1 J31.0;J32.9 31.48 - - None None None None
    1 1 Z48.8 86.59 - - None None None None
    1 1 Z09.8;J86. - - - None None None None
    2 1 Z09.8;J31.0 31.48 - - None None None None
    1 1 J31.0;J32.9 31.48 - - None None None None
    1 1 Z09.8;J31.0 31.48 - - None None None None
    2 1 H93.1;J00 31.48 - - None None None None
    1 1 Z48.8 - - - None None None None
    1 1 Z09.8;R10. - - - None None None None
    2 1 J00;H66.9 31.48 - - None None None None
    2 1 J32.0 31.48;87.1 - - None None None None
    2 1 O20.0 88.78 - - None None None None
    2 1 O34.2;O62 88.78 - - None None None None
    2 1 T17.0 98.12 - - None None None None
    2 1 R59.1 31.48 - - None None None None
    1 1 R59.1 31.48 - - None None None None
    1 1 J31.0;J06.8 31.48 - - None None None None
    2 1 J32.0 31.48;87.1 - - None None None None
    2 1 R04.0;J31. 31.48 - - None None None None
    2 1 J31.0;J32.9 31.48 - - None None None None
    2 1 J32.9;E05. 31.48 - - None None None None
    2 1 J31.0;J03.9 31.48 - - None None None None
    1 1 K11.2 31.48 - - None None None None
    1 1 Z71.9 - - - None None None None
    INACBG SUBACUTE CHRONIC SP SR SI SD DESKRIPSI TARIF_INA TARIF_SUB
    U-3-13-0 None None None None None None PROSEDUR 336100 0
    U-3-13-0 None None None None None None PROSEDUR 336100 0
    U-3-13-0 None None None None None None PROSEDUR 336100 0
    Q-5-44-0 None None None None None None PENYAKIT K 194700 0
    U-3-16-0 None None None None None None PROSEDUR 304800 0
    U-3-16-0 None None None None None None PROSEDUR 304800 0
    Q-5-12-0 None None None None None None GIGI DAN 221900 0
    Q-5-44-0 None None None None None None PENYAKIT K 194700 0
    Z-3-27-0 None None None None None None PERAWATA 211300 0
    Q-5-18-0 None None None None None None KONSULTAS 151100 0
    U-3-13-0 None None None None None None PROSEDUR 336100 0
    Q-5-44-0 None None None None None None PENYAKIT K 194700 0
    Q-5-44-0 None None None None None None PENYAKIT K 194700 0
    Q-5-44-0 None None None None None None PENYAKIT K 194700 0
    U-3-13-0 None None None None None None PROSEDUR 336100 0
    U-3-13-0 None None None None None None PROSEDUR 336100 0
    Q-5-25-0 None None None None None None GASTROINT 155800 0
    Q-5-44-0 None None None None None None PENYAKIT K 194700 0
    U-3-13-0 None None None None None None PROSEDUR 336100 0
    U-3-13-0 None None None None None None PROSEDUR 336100 0
    Q-5-44-0 None None None None None None PENYAKIT K 194700 0
    U-3-13-0 None None None None None None PROSEDUR 336100 0
    U-3-13-0 None None None None None None PROSEDUR 336100 0
    Q-5-43-0 None None None None None None PENYAKIT 281400 0
    U-3-13-0 None None None None None None PROSEDUR 336100 0
    U-3-13-0 None None None None None None PROSEDUR 336100 0
    U-3-13-0 None None None None None None PROSEDUR 336100 0
    U-3-13-0 None None None None None None PROSEDUR 336100 0
    U-3-13-0 None None None None None None PROSEDUR 336100 0
    U-3-13-0 None None None None None None PROSEDUR 336100 0
    Q-5-25-0 None None None None None None GASTROINT 155800 0
    Q-5-29-0 None None None None None None GAGAL JAN 559600 0
    H-2-33-0 None None None None None None PROSEDUR 274200 0
    Z-3-27-0 None None None None None None PERAWATA 211300 0
    U-3-13-0 None None None None None None PROSEDUR 336100 0
    U-3-13-0 None None None None None None PROSEDUR 336100 0
    U-3-13-0 None None None None None None PROSEDUR 336100 0
    U-3-13-0 None None None None None None PROSEDUR 336100 0
    U-3-13-0 None None None None None None PROSEDUR 336100 0
    U-3-13-0 None None None None None None PROSEDUR 336100 0
    U-3-13-0 None None None None None None PROSEDUR 336100 0
    U-3-13-0 None None None None None None PROSEDUR 336100 0
    U-3-13-0 None None None None None None PROSEDUR 336100 0
    U-3-13-0 None None None None None None PROSEDUR 336100 0
    U-3-13-0 None None None None None None PROSEDUR 336100 0
    U-3-13-0 None None None None None None PROSEDUR 336100 0
    M-3-16-0 None None None None None None PROSEDUR 120100 0
    Q-5-44-0 None None None None None None PENYAKIT K 194700 0
    U-3-13-0 None None None None None None PROSEDUR 336100 0
    U-3-13-0 None None None None None None PROSEDUR 336100 0
    U-3-13-0 None None None None None None PROSEDUR 336100 0
    U-3-13-0 None None None None None None PROSEDUR 336100 0
    U-3-16-0 None None None None None None PROSEDUR 304800 0
    U-3-13-0 None None None None None None PROSEDUR 336100 0
    U-3-13-0 None None None None None None PROSEDUR 336100 0
    Q-5-44-0 None None None None None None PENYAKIT K 194700 0
    U-3-13-0 None None None None None None PROSEDUR 336100 0
    M-3-16-0 None None None None None None PROSEDUR 120100 0
    U-3-13-0 None None None None None None PROSEDUR 336100 0
    U-3-13-0 None None None None None None PROSEDUR 336100 0
    L-3-12-0 None None None None None None PROSEDUR 219800 0
    Q-5-44-0 None None None None None None PENYAKIT K 194700 0
    U-3-13-0 None None None None None None PROSEDUR 336100 0
    U-3-13-0 None None None None None None PROSEDUR 336100 0
    U-3-13-0 None None None None None None PROSEDUR 336100 0
    U-3-13-0 None None None None None None PROSEDUR 336100 0
    Q-5-44-0 None None None None None None PENYAKIT K 194700 0
    Q-5-44-0 None None None None None None PENYAKIT K 194700 0
    U-3-13-0 None None None None None None PROSEDUR 336100 0
    U-3-13-0 None None None None None None PROSEDUR 336100 0
    Z-3-25-0 None None None None None None PROSEDUR 335100 0
    Z-3-25-0 None None None None None None PROSEDUR 335100 0
    U-3-15-0 None None None None None None PROSEDUR 269500 0
    U-3-13-0 None None None None None None PROSEDUR 336100 0
    U-3-13-0 None None None None None None PROSEDUR 336100 0
    U-3-13-0 None None None None None None PROSEDUR 336100 0
    U-3-13-0 None None None None None None PROSEDUR 336100 0
    U-3-13-0 None None None None None None PROSEDUR 336100 0
    U-3-13-0 None None None None None None PROSEDUR 336100 0
    U-3-13-0 None None None None None None PROSEDUR 336100 0
    U-3-13-0 None None None None None None PROSEDUR 336100 0
    U-3-13-0 None None None None None None PROSEDUR 336100 0
    Q-5-18-0 None None None None None None KONSULTAS 151100 0
    TARIF_CHRDESKRIPSI TARIF_SP DESKRIPSI TARIF_SR DESKRIPSI_TARIF_SI DESKRIPSI TARIF_SD TOTAL_TAR
    0- 0- 0- 0 - 0 336100
    0- 0- 0- 0 - 0 336100
    0- 0- 0- 0 - 0 336100
    0- 0- 0- 0 - 0 194700
    0- 0- 0- 0 - 0 304800
    0- 0- 0- 0 - 0 304800
    0- 0- 0- 0 - 0 221900
    0- 0- 0- 0 - 0 194700
    0- 0- 0- 0 - 0 211300
    0- 0- 0- 0 - 0 151100
    0- 0- 0- 0 - 0 336100
    0- 0- 0- 0 - 0 194700
    0- 0- 0- 0 - 0 194700
    0- 0- 0- 0 - 0 194700
    0- 0- 0- 0 - 0 336100
    0- 0- 0- 0 - 0 336100
    0- 0- 0- 0 - 0 155800
    0- 0- 0- 0 - 0 194700
    0- 0- 0- 0 - 0 336100
    0- 0- 0- 0 - 0 336100
    0- 0- 0- 0 - 0 194700
    0- 0- 0- 0 - 0 336100
    0- 0- 0- 0 - 0 336100
    0- 0- 0- 0 - 0 281400
    0- 0- 0- 0 - 0 336100
    0- 0- 0- 0 - 0 336100
    0- 0- 0- 0 - 0 336100
    0- 0- 0- 0 - 0 336100
    0- 0- 0- 0 - 0 336100
    0- 0- 0- 0 - 0 336100
    0- 0- 0- 0 - 0 155800
    0- 0- 0- 0 - 0 559600
    0- 0- 0- 0 - 0 274200
    0- 0- 0- 0 - 0 211300
    0- 0- 0- 0 - 0 336100
    0- 0- 0- 0 - 0 336100
    0- 0- 0- 0 - 0 336100
    0- 0- 0- 0 - 0 336100
    0- 0- 0- 0 - 0 336100
    0- 0- 0- 0 - 0 336100
    0- 0- 0- 0 - 0 336100
    0- 0- 0- 0 - 0 336100
    0- 0- 0- 0 - 0 336100
    0- 0- 0- 0 - 0 336100
    0 - 0 - 0 - 0 - 0 336100
    0 - 0 - 0 - 0 - 0 336100
    0 - 0 - 0 - 0 - 0 120100
    0 - 0 - 0 - 0 - 0 194700
    0 - 0 - 0 - 0 - 0 336100
    0 - 0 - 0 - 0 - 0 336100
    0 - 0 - 0 - 0 - 0 336100
    0 - 0 - 0 - 0 - 0 336100
    0 - 0 - 0 - 0 - 0 304800
    0 - 0 - 0 - 0 - 0 336100
    0 - 0 - 0 - 0 - 0 336100
    0 - 0 - 0 - 0 - 0 194700
    0 - 0 - 0 - 0 - 0 336100
    0 - 0 - 0 - 0 - 0 120100
    0 - 0 - 0 - 0 - 0 336100
    0 - 0 - 0 - 0 - 0 336100
    0 - 0 - 0 - 0 - 0 219800
    0 - 0 - 0 - 0 - 0 194700
    0 - 0 - 0 - 0 - 0 336100
    0 - 0 - 0 - 0 - 0 336100
    0 - 0 - 0 - 0 - 0 336100
    0 - 0 - 0 - 0 - 0 336100
    0 - 0 - 0 - 0 - 0 194700
    0 - 0 - 0 - 0 - 0 194700
    0 - 0 - 0 - 0 - 0 336100
    0 - 0 - 0 - 0 - 0 336100
    0 - 0 - 0 - 0 - 0 335100
    0 - 0 - 0 - 0 - 0 335100
    0 - 0 - 0 - 0 - 0 269500
    0 - 0 - 0 - 0 - 0 336100
    0 - 0 - 0 - 0 - 0 336100
    0 - 0 - 0 - 0 - 0 336100
    0 - 0 - 0 - 0 - 0 336100
    0 - 0 - 0 - 0 - 0 336100
    0 - 0 - 0 - 0 - 0 336100
    0 - 0 - 0 - 0 - 0 336100
    0 - 0 - 0 - 0 - 0 336100
    0 - 0 - 0 - 0 - 0 336100
    0 - 0 - 0 - 0 - 0 151100
    TARIF_RS TARIF_POL LOS ICU_INDIK ICU_LOS VENT_HOUNAMA_PASMRN UMUR_TA UMUR_HAR
    157700 0 1 0 0 0 Laura Octa 37 15 28 27 9890
    195000 0 1 0 0 0 AULLIYA H 30 89 60 4 1735
    144000 0 1 0 0 0 DARMIN 39 87 65 38 14185
    111000 0 1 0 0 0 DAMURI 34 54 28 50 18355
    145000 0 1 0 0 0 CHRISTIAN 25 55 72 7 2614
    139997 0 1 0 0 0 RASMIAL D11 25 43 44 16372
    70000 0 1 0 0 0 CINDY EKA 11 98 90 28 10592
    122500 0 1 0 0 0 TUTANG M18 44 49 26 9748
    180500 0 1 0 0 0 SITI FADIL 39 82 47 49 18143
    85000 0 1 0 0 0 fauziah 20 65 96 36 13224
    198700 0 1 0 0 0 TANDI NAI 02 44 59 61 22448
    145500 0 1 0 0 0 MISWANTI 36 06 28 38 13902
    94000 0 1 0 0 0 DARMAWAN 39 78 59 21 7778
    204500 0 1 0 0 0 SUMARSO 34 27 58 54 19858
    167000 0 1 0 0 0 ERIN MUTI 39 88 93 34 12735
    177500 0 1 0 0 0 M. Fauzi 20 39 55 7 2612
    93500 0 1 0 0 0 REPITA MA16 00 68 34 12426
    105000 0 1 0 0 0 RINI JANU 39 88 87 45 16725
    168000 0 1 0 0 0 R AWENAN36 68 09 43 16053
    258500 0 1 0 0 0 FITRIYANI 39 79 10 3 1180
    168500 0 1 0 0 0 SRI EKA PU19 03 43 44 16261
    136197 0 1 0 0 0 Wasni Tam 08 93 02 47 17417
    190000 0 1 0 0 0 ROXANNE 00 52 07 11 4366
    190000 0 1 0 0 0 ERNI 39 91 32 55 20147
    165500 0 1 0 0 0 ARI WIDIA 10 19 38 26 9784
    196500 0 1 0 0 0 PURNAWAT11 91 31 42 15392
    139000 0 1 0 0 0 Laura Octa 37 15 28 27 9898
    269000 0 1 0 0 0 HENIPUJIH 39 92 60 41 15309
    252200 0 1 0 0 0 MASHURI 39 93 27 41 14990
    196500 0 1 0 0 0 WAHYU HI 39 93 72 19 7020
    93500 0 1 0 0 0 I WAYAN 05 98 67 33 12075
    114500 0 1 0 0 0 APOSTER H08 98 26 44 16172
    327500 0 1 0 0 0 ANDRI SOL 39 93 41 38 14091
    150000 0 1 0 0 0 SOGIRAN 27 27 56 65 23789
    161200 0 1 0 0 0 ERWIS DAR19 08 54 31 11486
    151200 0 1 0 0 0 WAHYU HI 39 93 72 19 7025
    165700 0 1 0 0 0 PRILLY SYA 39 91 75 4 1668
    187700 0 1 0 0 0 MUNAWAR39 93 43 33 12076
    169500 0 1 0 0 0 ANISAH SR 35 82 70 20 7538
    263000 0 1 0 0 0 ARTIKA SA 39 96 68 7 2864
    284000 0 1 0 0 0 IRFAN ARD 32 41 67 5 2103
    185200 0 1 0 0 0 ZAHRATUL 39 98 08 7 2770
    179200 0 1 0 0 0 RAIHAN AU39 98 77 7 2877
    208500 0 1 0 0 0 IMA MARL 38 96 41 28 10236
    209200 0 1 0 0 0 BALEO HA 33 24 60 23 8552
    220700 0 1 0 0 0 SYIFA NUR 39 98 82 7 2829
    125000 0 1 0 0 0 ISAH 31 64 06 62 22927
    149000 0 1 0 0 0 UMI SALA 19 73 83 50 18597
    207500 0 1 0 0 0 ADI MAND 07 97 27 27 9959
    205200 0 1 0 0 0 FREDDY MA21 00 07 37 13768
    192200 0 1 0 0 0 BANU ADI 35 23 21 5 2038
    614200 0 1 0 0 0 SANSHIKA 39 00 88 40 14705
    265000 0 1 0 0 0 JAMIL ZA 39 89 35 57 20947
    140200 0 1 0 0 0 IMA MARL 38 96 41 28 10240
    224000 0 1 0 0 0 IRFAN ARD 32 41 67 5 2108
    122500 0 1 0 0 0 MARINGAN36 06 30 56 20565
    190200 0 1 0 0 0 RAJA AIDIL 21 22 75 35 12849
    60000 0 1 0 0 0 AMIR HAM10 39 36 57 21157
    439700 0 1 0 0 0 YESI RISKI 40 02 26 24 8850
    144000 0 1 0 0 0 R.M. ASYU 28 33 15 35 12832
    167500 0 1 0 0 0 TARSISIUS 20 21 00 32 12017
    148000 0 1 0 0 0 SAEFUL HI 30 55 75 47 17485
    171500 0 1 0 0 0 PUTRI NOL 39 35 24 25 9347
    209200 0 1 0 0 0 MUSTARIDI38 74 29 38 14051
    157700 0 1 0 0 0 AKHIRUDD 32 87 67 61 22486
    171700 0 1 0 0 0 SANTI AYU 40 02 91 30 11214
    95000 0 1 0 0 0 IKRAL 04 10 54 40 14638
    130000 0 1 0 0 0 HAZOGUNA40 03 53 38 14077
    184000 0 1 0 0 0 KEZIA 40 04 98 7 2747
    286500 0 1 0 0 0 FITRI RATN 40 04 96 22 8291
    183000 0 1 0 0 0 ANIS MAH 05 08 18 30 11168
    223000 0 1 0 0 0 GALUH SRI 25 32 44 30 11229
    137100 0 1 0 0 0 FAITH SAF 40 04 52 3 1218
    140200 0 1 0 0 0 NURHAYATI40 05 29 35 12904
    140200 0 1 0 0 0 RIDMAN PR19 02 16 43 15957
    179200 0 1 0 0 0 WIRA JUN 18 25 24 7 2631
    268500 0 1 0 0 0 NELLY CH 04 85 09 51 18792
    168000 0 1 0 0 0 RAMADHAN 09 54 34 13 4765
    208000 0 1 0 0 0 ERMIYANTI28 07 69 31 11663
    168700 0 1 0 0 0 NOVRIA KU40 05 92 38 13895
    210500 0 1 0 0 0 LATIVA UT 40 06 09 21 7817
    188000 0 1 0 0 0 M. REVAN 40 06 36 4 1679
    85000 0 1 0 0 0 ILIAS SEPT 37 22 09 1 430
    DPJP SEP NOKARTU PAYOR_ID CODER_ID VERSI_INA VERSI_GR C1 C2 C3
    ERIYANTO,S0407R0021 1.5E+09 3;JKN Sega Prira 5.1.0.201 4 141096 1#0##0#0# 3
    TEPPY HAR0407R0021 1.39E+09 3;JKN Sega Prira 5.1.0.201 4 134258 1#0##0#0# 5
    TEPPY HAR0407R0021 1.86E+09 3;JKN Sega Prira 5.1.0.201 4 134260 1#0##0#0# 5
    DINDIN H 0407R0021 3.66E+08 3;JKN Sega Prira 5.1.0.201 4 134511 1#0##0#0# 7
    RINA KATAT0407R0021 1.27E+09 3;JKN Sega Prira 5.1.0.201 4 134374 1#0##0#0# 5
    RINA KATAT0407R002122943441 3;JKN Sega Prira 5.1.0.201 4 141098 1#0##0#0# 3
    RINA KATAT0407R0021 1.39E+09 3;JKN Sega Prira 5.1.0.201 4 134338 1#0##0#0# 5
    TAMSIL ,SP0407R0021 1E+09 3;JKN Sega Prira 5.1.0.201 4 134205 1#0##0#0# 5
    TAMSIL ,SP0407R0021 1.28E+09 3;JKN Sega Prira 5.1.0.201 4 134201 1#0##0#0# 6
    SRI RAFEL 0407R0021 1.38E+09 3;JKN Sega Prira 5.1.0.201 4 134310 1#0##0#0# 5
    ERIYANTO,S0407R002122967021 3;JKN Sega Prira 5.1.0.201 4 134454 1#0##0#0# 5
    M. NUHADI.0407R0021 3.65E+08 3;JKN Sega Prira 5.1.0.201 4 134432 1#0##0#0# 6
    AGUS PERM0407R0021 2.04E+09 3;JKN Sega Prira 5.1.0.201 4 134353 1#0##0#0# 5
    AGUS PERM0407R0021 1.33E+09 3;JKN Sega Prira 5.1.0.201 4 134350 1#0##0#0# 5
    ERIYANTO,S0407R0021 1.86E+09 3;JKN Sega Prira 5.1.0.201 4 134669 1#0##0#0# 5
    ERIYANTO,S0407R0021 1.49E+09 3;JKN Sega Prira 5.1.0.201 4 141099 1#0##0#0# 3
    DINDIN H 0407R0021 1.5E+09 3;JKN Sega Prira 5.1.0.201 4 134644 1#0##0#0# 7
    DINDIN H 0407R0021 1.72E+09 3;JKN Sega Prira 5.1.0.201 4 134671 1#0##0#0# 6
    ERIYANTO,S0407R0021 1.2E+09 3;JKN Sega Prira 5.1.0.201 4 134956 1#0##0#0# 3
    ERIYANTO,S0407R0021 1.27E+09 3;JKN Sega Prira 5.1.0.201 4 134954 1#0##0#0# 3
    DANANG LE0407R0021 1.13E+09 3;JKN Sega Prira 5.1.0.201 4 142983 1#0##0#0# 2
    ERIYANTO,S0407R0021 1.62E+09 3;JKN Sega Prira 5.1.0.201 4 134198 1#0##0#0# 5
    ERIYANTO,S0407R0021 1.39E+09 3;JKN Sega Prira 5.1.0.201 4 135261 1#0##0#0# 3
    VICTOR JE 0407R002115580001 3;JKN Sega Prira 5.1.0.201 4 136179 1#0##0#0# 4
    ERIYANTO,S0407R0021 1.28E+09 3;JKN Sega Prira 5.1.0.201 4 136230 1#0##0#0# 3
    ERIYANTO,S0407R002122851066 3;JKN Sega Prira 5.1.0.201 4 136225 1#0##0#0# 3
    ERIYANTO,S0407R0021 1.5E+09 3;JKN Sega Prira 5.1.0.201 4 136276 1#0##0#0# 3
    ERIYANTO,S0407R0021 1.17E+09 3;JKN Sega Prira 5.1.0.201 4 136281 1#0##0#0# 3
    ERIYANTO,S0407R0021 1.62E+09 3;JKN Sega Prira 5.1.0.201 4 134736 1#0##0#0# 6
    ERIYANTO,S0407R0021 1.86E+09 3;JKN Sega Prira 5.1.0.201 4 136767 1#0##0#0# 3
    DESVALDI, 0407R0021 1.5E+09 3;JKN Sega Prira 5.1.0.201 4 136759 1#0##0#0# 7
    DR. M. YA 0407R0021 1.41E+09 3;JKN Sega Prira 5.1.0.201 4 136754 1#0##0#0# 3
    NANI KUST0407R0021 1.62E+09 3;JKN Sega Prira 5.1.0.201 4 134734 1#0##0#0# 6
    VICTOR JE 0407R0021 1.26E+09 3;JKN Sega Prira 5.1.0.201 4 137686 1#0##0#0# 3
    ERIYANTO,S0407R0021 3.66E+08 3;JKN Sega Prira 5.1.0.201 4 137751 1#0##0#0# 3
    ERIYANTO,S0407R0021 1.86E+09 3;JKN Sega Prira 5.1.0.201 4 138210 1#0##0#0# 3
    ERIYANTO,S0407R0021 2.06E+09 3;JKN Sega Prira 5.1.0.201 4 138209 1#0##0#0# 3
    ERIYANTO,S0407R0021 2E+08 3;JKN Sega Prira 5.1.0.201 4 138111 1#0##0#0# 3
    ERIYANTO,S0407R0021 3.66E+08 3;JKN Sega Prira 5.1.0.201 4 138142 1#0##0#0# 3
    ERIYANTO,S0407R0021 2.05E+09 3;JKN Sega Prira 5.1.0.201 4 135076 1#0##0#0# 4
    ERIYANTO,S0407R0021 1.48E+09 3;JKN Sega Prira 5.1.0.201 4 138628 1#0##0#0# 4
    ERIYANTO,S0407R0021 2.05E+09 3;JKN Sega Prira 5.1.0.201 4 138547 1#0##0#0# 3
    ERIYANTO,S0407R0021 1.6E+09 3;JKN Sega Prira 5.1.0.201 4 139466 1#0##0#0# 3
    ERIYANTO,S0407R0021 1.5E+09 3;JKN Sega Prira 5.1.0.201 4 139465 1#0##0#0# 3
    ERIYANTO,S0407R0021 1.63E+09 3;JKN Sega Prira 5.1.0.201 4 139463 1#0##0#0# 3
    ERIYANTO,S0407R0021 1.18E+09 3;JKN Sega Prira 5.1.0.201 4 139462 1#0##0#0# 3
    AGUS RAKH0407R002123019838 3;JKN Sega Prira 5.1.0.201 4 139375 1#0##0#0# 3
    DINDIN H 0407R0021 1.11E+09 3;JKN Sega Prira 5.1.0.201 4 139352 1#0##0#0# 3
    ERIYANTO,S0407R0021 1.13E+09 3;JKN Sega Prira 5.1.0.201 4 139495 1#0##0#0# 3
    ERIYANTO,S0407R0021 1.8E+09 3;JKN Sega Prira 5.1.0.201 4 139708 1#0##0#0# 3
    ERIYANTO,S0407R0021 2.07E+09 3;JKN Sega Prira 5.1.0.201 4 139707 1#0##0#0# 3
    ERIYANTO,S0407R0021 1.61E+09 3;JKN Sega Prira 5.1.0.201 4 134793 1#0##0#0# 6
    JUANNA SO0407R0021 2.04E+09 3;JKN Sega Prira 5.1.0.201 4 142980 1#0##0#0# 2
    ERIYANTO,S0407R0021 1.5E+09 3;JKN Sega Prira 5.1.0.201 4 139768 1#0##0#0# 3
    ERIYANTO,S0407R0021 1.48E+09 3;JKN Sega Prira 5.1.0.201 4 139878 1#0##0#0# 3
    YUNI LIDYA0407R0021 1.79E+09 3;JKN Sega Prira 5.1.0.201 4 139906 1#0##0#0# 3
    ERIYANTO,S0407R0021 1.13E+09 3;JKN Sega Prira 5.1.0.201 4 139599 1#0##0#0# 3
    AGUS RAKH0407R002122560017 3;JKN Sega Prira 5.1.0.201 4 142982 1#0##0#0# 2
    ERIYANTO,S0407R0021 1.6E+09 3;JKN Sega Prira 5.1.0.201 4 135990 1#0##0#0# 3
    ERIYANTO,S0407R002122858288 3;JKN Sega Prira 5.1.0.201 4 138691 1#0##0#0# 3
    TAMSIL ,SP0407R0021 1.28E+09 3;JKN Sega Prira 5.1.0.201 4 138734 1#0##0#0# 4
    MUNTAFIAH 0407R0021 1.14E+09 3;JKN Sega Prira 5.1.0.201 4 138295 1#0##0#0# 3
    ERIYANTO,S0407R0021 1.88E+09 3;JKN Sega Prira 5.1.0.201 4 138308 1#0##0#0# 3
    ERIYANTO,S0407R0021 1.09E+09 3;JKN Sega Prira 5.1.0.201 4 138334 1#0##0#0# 3
    ERIYANTO,S0407R0021 1.31E+09 3;JKN Sega Prira 5.1.0.201 4 138333 1#0##0#0# 4
    ERIYANTO,S0407R0021 1.61E+09 3;JKN Sega Prira 5.1.0.201 4 138258 1#0##0#0# 3
    M. NUHADI.0407R0021 1.62E+09 3;JKN Sega Prira 5.1.0.201 4 138261 1#0##0#0# 3
    TAMSIL ,SP0407R0021 2.51E+08 3;JKN Sega Prira 5.1.0.201 4 142979 1#0##0#0# 2
    ERIYANTO,S0407R0021 1.86E+09 3;JKN Sega Prira 5.1.0.201 4 139087 1#0##0#0# 3
    ERIYANTO,S0407R0021 1.45E+09 3;JKN Sega Prira 5.1.0.201 4 140050 1#0##0#0# 3
    DECYARAN 0407R0021 1.19E+09 3;JKN Sega Prira 5.1.0.201 4 139117 1#0##0#0# 3
    DECYARAN 0407R0021 1.18E+09 3;JKN Sega Prira 5.1.0.201 4 139137 1#0##0#0# 3
    ERIYANTO,S0407R0021 1.8E+09 3;JKN Sega Prira 5.1.0.201 4 139083 1#0##0#0# 3
    ERIYANTO,S0407R0021 3.65E+08 3;JKN Sega Prira 5.1.0.201 4 139940 1#0##0#0# 3
    ERIYANTO,S0407R0021 2.07E+09 3;JKN Sega Prira 5.1.0.201 4 139938 1#0##0#0# 3
    ERIYANTO,S0407R0021 1.47E+09 3;JKN Sega Prira 5.1.0.201 4 139942 1#0##0#0# 3
    ERIYANTO,S0407R002122901692 3;JKN Sega Prira 5.1.0.201 4 140045 1#0##0#0# 3
    ERIYANTO,S0407R0021 1.86E+09 3;JKN Sega Prira 5.1.0.201 4 140046 1#0##0#0# 3
    ERIYANTO,S0407R002125323028 3;JKN Sega Prira 5.1.0.201 4 140049 1#0##0#0# 3
    ERIYANTO,S0407R0021 1.87E+09 3;JKN Sega Prira 5.1.0.201 4 140113 1#0##0#0# 4
    ERIYANTO,S0407R0021 1.9E+09 3;JKN Sega Prira 5.1.0.201 4 140038 1#0##0#0# 3
    ERIYANTO,S0407R0021 1.84E+09 3;JKN Sega Prira 5.1.0.201 4 140053 1#0##0#0# 3
    NANI KUST0407R0021 2.05E+09 3;JKN Sega Prira 5.1.0.201 4 140025 1#0##0#0# 3
    C4
    3f9d7f11cc660c6907f072be2396c958
    7d98c8fdadb3337c1b4bdcd39a471c6a
    80083e924c4c2bbbc670b6d132ec5000
    ece13d185df64f3fc14618ce6d756e8c
    1f0ed57b8e81d120c3c84ce64b17a854
    dd5731877370074fd89a3449d6b4b80e
    4ed18cf25936c1fb36900101ee6d7a0f
    20bccce0d750ac5c3bedf540fdf65461
    400e39e1824863e600544a91c55b549c
    e4731c0754294aaa4988fe2df58a8c6d
    db5d514eeaceabec84b9c3a842844d1f
    df51e56d137acac976107bf318dbd4fd
    821c5968b128e49944d76ee5b3630c01
    8f6b81cc88f7bcc1b227b103f0ef153b
    bc9c231547e9d4768f8f819e10728a22
    fad746c16d6e261f5e34fdb6021c3f70
    ce6be9c094d0dbc802ee9bef7a4899f0
    1d34ca165e80c3bbd098334c722ef707
    d92956ac028d0648d6c4236fbf9404b4
    acdd99101f53cec6c241147275e3bbf9
    e21ce247940adafc81c48d65cc06b0f8
    7995eca7d515b43404faaee0fe4cf959
    fbeb52e7e9785e572d27bc4bb534865e
    0ef5ddedeb088185b8f6c174ecb569a7
    89cf5c49c7608a74869bc3e10ab6f1d4
    06ee6a50891ac3fa89f85aa8509a87d4
    560cd84615d6a38c6663b1b910755fb0
    099b536c5ace108e279123b9fa47413a
    9b20a76b677f922857fb4e2d7880e81c
    f1e61acbb4d1a5dfff60d97628f8c399
    d472cbfeb9212b08d2f8e5ab78eb43c9
    28232cf84704f5a103b47bc19ff8d43b
    8d8c956665c4f4fb5c80b6b4ea5f79d1
    96b144a2d339ffa63d04b6947ddcec6a
    911b68d7c2969bb2809453b77d6e8409
    46665f0efa31f6328db1f4b7478d57e0
    63ba3770e404bc32c610194d9a4fca98
    773994aa2e098ffd2271ad311b5196c5
    4f293635f92e497a5b7b3b148bf005c2
    b946aa06ff1af5cbaaf82732690edfce
    58b38c4a45eb10b75e8a978b8b8d2b44
    a8713b72100af6f3cdb97356ff256d70
    58459663a95a9b5a0a52a46cfa66a9d5
    de62e540f3065ceacf5e087fbb960ba1
    72ddd6f06c5ae0054d0c084f8ac3b116
    ea226e3c7fa23272d09da21b297bf92e
    d6645a1235066d29bf4e21f53799878c
    e3c9d4e21dcbc9c56a82f989c6ad7179
    1c94c832121cdbcfea899df2883a7ad0
    9654259b3cc6cf5dd9d618ea270887a7
    58620666919e2baacda5d57851980a84
    458f0706d0fa6392e202c06075885002
    b72e2c3cb47ebbc8a89377399a6f32ee
    ee8f50f41eedf6d4362757ee4baa0fe8
    17a24c8763ffa3d4571cd8f2b6755bf3
    6c711f3a34f26e717a70afd34fb03abf
    476b2376075d5cdb4b754522a033c9b3
    e228053244c588c80576d7863375ac34
    6138c1374357191627b8a870b236d86e
    c1f2810f14a4f621e60f462bb8f07136
    8c633c3fedf18ae49a7291f5ff938dd1
    e1708e68234380ae94771594c4d6ea0d
    d741064034f915e5a11024ef8fe9913c
    f0ae4e432e5ec9a415f9e3cacbbc7c29
    2ceb2af78ad134d6ad79ac73cfd870cb
    99c7590822abcaee54c6cdfd34970835
    9acdc01572ab58934d2abcc1aa850146
    9be9a74f1d8f46e3cef020c5c4eed2aa
    cc11721adbec4fa35d034e771ddaef2c
    90e5b1983a5d40d6d5a559337a59f9a2
    ce9df204e69f34fe82b26076b3198026
    865efce73609df180e24f57670e0b297
    eb02f8371a1212b82e9398ab0822a6b4
    8d5178cbef4790020ccffe47e8b18d8a
    33decc848fbd4643596ba933cc2939a1
    913b97a04ea2d8a6310a0dbe127425e6
    fadd5ee6cbb781ef7d94ca4a29348425
    8a706a305c77c33314a1a4187ca18aff
    521478c3808339e20d728935aae9514b
    6d1fbb5de568fe3fd240b69baac8634b
    233463d2b7422f425c64d0397489a702
    4f4389e176017acfcd1d3ec0c675ac8d
    015804e3671e594d5d2a32423a0c6698
    REVISI KLAIM RAWAT JAL
    BULAN NOVEMBER 201

    No Tgl. Masuk MRN NAMA_PASIEN SEP

    1 11/1/2016 37 15 28 Laura Octamy M. 0407R00211160000113


    2 11/1/2016 30 89 60 AULLIYA HUSNA ANFRI 0407R00211160000178
    3 11/1/2016 39 87 65 DARMIN 0407R00211160000189
    4 11/1/2016 34 54 28 DAMURI 0407R00211160000082
    5 11/1/2016 25 55 72 CHRISTIAN LEONARDO TANDY 0407R00211160000223
    6 11/1/2016 11 25 43 RASMIAL DEWI 0407R00211160000093
    7 11/1/2016 11 98 90 CINDY EKA RATNA SARI 0407R00211160000094
    8 11/1/2016 18 44 49 TUTANG MULYANA 0407R00211160000106
    9 11/1/2016 39 82 47 SITI FADILAH 0407R00211160000161
    10 11/1/2016 20 65 96 fauziah 0407R00211160000146
    11 11/2/2016 02 44 59 TANDI NAIBAHO 0407R00211160000311
    12 11/2/2016 36 06 28 MISWANTI 0407R00211160000332
    13 11/2/2016 39 78 59 DARMAWANSYAH PUTRA 0407R00211160000432
    14 11/2/2016 34 27 58 SUMARSONO 0407R00211160000421
    15 11/3/2016 39 88 93 ERIN MUTIA SHINTA 0407R00211160000581
    16 11/3/2016 20 39 55 M. Fauzi Ramadhan 0407R00211160000566
    17 11/3/2016 16 00 68 REPITA MANALU 0407R00211160000550
    18 11/3/2016 39 88 87 RINI JANUARDI 0407R00211160000549
    19 11/4/2016 36 68 09 R AWENANDREASTAMALIA PANGHAW 0407R00211160000699
    20 11/4/2016 39 79 10 FITRIYANITA HERIYANTO 0407R00211160000711
    21 11/4/2016 19 03 43 SRI EKA PUTRI 0407R00211160005315
    22 11/7/2016 08 93 02 Wasni Tambunan 0407R00211160001092
    23 11/7/2016 00 52 07 ROXANNE RAHMATIA NINGRUM 0407R00211160001116
    24 11/7/2016 39 91 32 ERNI 0407R00211160001151
    25 11/8/2016 10 19 38 ARI WIDIAWATI 0407R00211160001267
    26 11/8/2016 11 91 31 PURNAWATI NASUTION 0407R00211160001344
    27 11/9/2016 37 15 28 Laura Octamy M. 0407R00211160001504
    28 11/9/2016 39 92 60 HENIPUJIHASTUTI 0407R00211160001482
    29 11/10/2016 39 93 27 MASHURI 0407R00211160001704
    30 11/10/2016 39 93 72 WAHYU HIDAYAT 0407R00211160001807
    31 11/10/2016 05 98 67 I WAYAN PURUSHOTTAMA 0407R00211160001768
    32 11/10/2016 08 98 26 APOSTER H 0407R00211160001611
    33 11/10/2016 39 93 41 ANDRI SOLIS 0407R00211160001734
    34 11/11/2016 27 27 56 SOGIRAN 0407R00211160001893
    35 11/11/2016 19 08 54 ERWIS DARLIAH S 0407R00211160001858
    36 11/15/2016 39 93 72 WAHYU HIDAYAT 0407R00211160002446
    37 11/15/2016 39 91 75 PRILLY SYAPUTRI ADELIA 0407R00211160002481
    38 11/15/2016 39 93 43 MUNAWARAH 0407R00211160002573
    39 11/15/2016 35 82 70 ANISAH SRIULINA G 0407R00211160002606
    40 11/15/2016 39 96 68 ARTIKA SAHARANI 0407R00211160002612
    41 11/17/2016 32 41 67 IRFAN ARDIANSA 0407R00211160002948
    42 11/17/2016 39 98 08 ZAHRATUL FIRASYA 0407R00211160003020
    43 11/18/2016 39 98 77 RAIHAN AUFA HAFIZ SETYAWAN 0407R00211160003188
    44 11/18/2016 38 96 41 IMA MARLINA 0407R00211160003215
    45 11/18/2016 33 24 60 BALEO HALOMOAN HARAHAP 0407R00211160003246
    46 11/18/2016 39 98 82 SYIFA NUR HIDAYAH 0407R00211160003206
    47 11/18/2016 31 64 06 ISAH 0407R00211160003083
    48 11/18/2016 19 73 83 UMI SALAMAH 0407R00211160003077
    49 11/21/2016 07 97 27 ADI MANDALA 0407R00211160003477
    50 11/21/2016 21 00 07 FREDDY MAROLOP SIAGIAN 0407R00211160003618
    51 11/21/2016 35 23 21 BANU ADIYATMA 0407R00211160003613
    52 11/21/2016 39 00 88 SANSHIKA MARISTA 0407R00211160003553
    53 11/21/2016 39 89 35 JAMIL ZAMZAM 0407R00211160005313
    54 11/22/2016 38 96 41 IMA MARLINA 0407R00211160003844
    55 11/22/2016 32 41 67 IRFAN ARDIANSA 0407R00211160003768
    56 11/22/2016 36 06 30 MARINGAN PASARIBU 0407R00211160003853
    57 11/23/2016 21 22 75 RAJA AIDIL PAISAL 0407R00211160004365
    58 11/23/2016 10 39 36 AMIR HAMZAH 0407R00211160005314
    59 11/24/2016 40 02 26 YESI RISKITE DARINE 0407R00211160004153
    60 11/24/2016 28 33 15 R.M. ASYURIANDI 0407R00211160004100
    61 11/24/2016 20 21 00 TARSISIUS TUA 0407R00211160004096
    62 11/25/2016 30 55 75 SAEFUL HIDAYAT 0407R00211160004432
    63 11/25/2016 39 35 24 PUTRI NOLANDa 0407R00211160004434
    64 11/25/2016 38 74 29 MUSTARIDI, S. Kom 0407R00211160004303
    65 11/25/2016 32 87 67 AKHIRUDDIN 0407R00211160004292
    66 11/25/2016 40 02 91 SANTI AYU SAFITRI 0407R00211160004340
    67 11/25/2016 04 10 54 IKRAL 0407R00211160004413
    68 11/26/2016 40 03 53 HAZOGUNA SIHURA 0407R00211160005312
    69 11/28/2016 40 04 98 KEZIA 0407R00211160004854
    70 11/28/2016 40 04 96 FITRI RATNASARI 0407R00211160004837
    71 11/28/2016 05 08 18 ANIS MAHFIROH 0407R00211160004723
    72 11/28/2016 25 32 44 GALUH SRI HARTATI 0407R00211160004858
    73 11/28/2016 40 04 52 FAITH SAFARAZ ARIFAH 0407R00211160004721
    74 11/29/2016 40 05 29 NURHAYATI 0407R00211160004955
    75 11/29/2016 19 02 16 RIDMAN PRESTO SINSU 0407R00211160004989
    76 11/29/2016 18 25 24 WIRA JUNIOR RAMADHAN 0407R00211160004993
    77 11/29/2016 04 85 09 NELLY CHANDRAWATY M 0407R00211160005083
    78 11/30/2016 09 54 34 RAMADHANI PUSPA ROKHIM 0407R00211160005257
    79 11/30/2016 28 07 69 ERMIYANTI 0407R00211160005276
    80 11/30/2016 40 05 92 NOVRIA KUMALA SARI 0407R00211160005174
    81 11/30/2016 40 06 09 LATIVA UTAMI 0407R00211160005231
    82 11/30/2016 40 06 36 M. REVAN APRILIO 0407R00211160005291
    83 11/30/2016 37 22 09 ILIAS SEPTHYADI ZEBUA 0407R00211160005151
    84 11/22/2016 40 01 02 Saidah Nur Alfi Tambunan 0407R00211160003832
    TOTAL :

    Batam, 22 November 2016


    Petugas RSBK

    SEGA PRIRAHMADAN

    Mengetahui,

    dr. Anjari Wahyu Wardhani


    Ketua Tim Pengendali JKN
    EVISI KLAIM RAWAT JALAN
    BULAN NOVEMBER 2016

    Tarif INA-CBG's
    KODE TARIF RS Tarif klaim selisih
    INACB'S Tarif Revisi
    awal
    U-3-13-0 Rp 157,700 Rp 409,700 Rp 336,100 Rp 73,600
    U-3-13-0 Rp 195,000 Rp 409,700 Rp 336,100 Rp 73,600
    U-3-13-0 Rp 144,000 Rp 409,700 Rp 336,100 Rp 73,600
    Q-5-44-0 Rp 111,000 Rp 194,700 Rp 194,700 Rp -
    U-3-16-0 Rp 145,000 Rp 304,800 Rp 304,800 Rp -
    U-3-16-0 Rp 139,997 Rp 304,800 Rp 304,800 Rp -
    Q-5-12-0 Rp 70,000 Rp 221,900 Rp 221,900 Rp -
    Q-5-44-0 Rp 122,500 Rp 194,700 Rp 194,700 Rp -
    Z-3-27-0 Rp 180,500 Rp 211,300 Rp 211,300 Rp -
    Q-5-18-0 Rp 85,000 Rp 151,100 Rp 151,100 Rp -
    U-3-13-0 Rp 198,700 Rp 409,700 Rp 336,100 Rp 73,600
    Q-5-44-0 Rp 145,500 Rp 194,700 Rp 194,700 Rp -
    Q-5-44-0 Rp 94,000 Rp 194,700 Rp 194,700 Rp -
    Q-5-44-0 Rp 204,500 Rp 194,700 Rp 194,700 Rp -
    U-3-13-0 Rp 167,000 Rp 409,700 Rp 336,100 Rp 73,600
    U-3-13-0 Rp 177,500 Rp 409,700 Rp 336,100 Rp 73,600
    Q-5-25-0 Rp 93,500 Rp 155,800 Rp 155,800 Rp -
    Q-5-44-0 Rp 105,000 Rp 194,700 Rp 194,700 Rp -
    U-3-13-0 Rp 168,000 Rp 409,700 Rp 336,100 Rp 73,600
    U-3-13-0 Rp 258,500 Rp 409,700 Rp 336,100 Rp 73,600
    Q-5-44-0 Rp 168,500 Rp 194,700 - -
    U-3-13-0 Rp 136,197 Rp 409,700 Rp 336,100 Rp 73,600
    U-3-13-0 Rp 190,000 Rp 409,700 Rp 336,100 Rp 73,600
    Q-5-43-0 Rp 190,000 Rp 281,400 Rp 281,400 Rp -
    U-3-13-0 Rp 165,500 Rp 409,700 Rp 336,100 Rp 73,600
    U-3-13-0 Rp 196,500 Rp 409,700 Rp 336,100 Rp 73,600
    U-3-13-0 Rp 139,000 Rp 409,700 Rp 336,100 Rp 73,600
    U-3-13-0 Rp 269,000 Rp 409,700 Rp 336,100 Rp 73,600
    U-3-13-0 Rp 252,200 Rp 409,700 Rp 336,100 Rp 73,600
    U-3-13-0 Rp 196,500 Rp 409,700 Rp 336,100 Rp 73,600
    Q-5-25-0 Rp 93,500 Rp 155,800 Rp 155,800 Rp -
    Q-5-29-0 Rp 114,500 Rp 559,600 Rp 559,600 Rp -
    H-2-33-0 Rp 327,500 Rp 274,200 Rp 274,200 Rp -
    Z-3-27-0 Rp 150,000 Rp 211,300 Rp 211,300 Rp -
    U-3-13-0 Rp 161,200 Rp 409,700 Rp 336,100 Rp 73,600
    U-3-13-0 Rp 151,200 Rp 409,700 Rp 336,100 Rp 73,600
    U-3-13-0 Rp 165,700 Rp 409,700 Rp 336,100 Rp 73,600
    U-3-13-0 Rp 187,700 Rp 409,700 Rp 336,100 Rp 73,600
    U-3-13-0 Rp 169,500 Rp 409,700 Rp 336,100 Rp 73,600
    U-3-13-0 Rp 263,000 Rp 409,700 Rp 336,100 Rp 73,600
    U-3-13-0 Rp 284,000 Rp 409,700 Rp 336,100 Rp 73,600
    U-3-13-0 Rp 185,200 Rp 409,700 Rp 336,100 Rp 73,600
    U-3-13-0 Rp 179,200 Rp 409,700 Rp 336,100 Rp 73,600
    U-3-13-0 Rp 208,500 Rp 409,700 Rp 336,100 Rp 73,600
    U-3-13-0 Rp 209,200 Rp 409,700 Rp 336,100 Rp 73,600
    U-3-13-0 Rp 220,700 Rp 409,700 Rp 336,100 Rp 73,600
    M-3-16-0 Rp 125,000 Rp 163,400 Rp 120,100 Rp 43,300
    Q-5-44-0 Rp 149,000 Rp 194,700 Rp 194,700 Rp -
    U-3-13-0 Rp 207,500 Rp 409,700 Rp 336,100 Rp 73,600
    U-3-13-0 Rp 205,200 Rp 409,700 Rp 336,100 Rp 73,600
    U-3-13-0 Rp 192,200 Rp 409,700 Rp 336,100 Rp 73,600
    U-3-13-0 Rp 614,200 Rp 409,700 Rp 336,100 Rp 73,600
    U-3-16-0 Rp 265,000 Rp 304,800 - -
    U-3-13-0 Rp 140,200 Rp 409,700 Rp 336,100 Rp 73,600
    U-3-13-0 Rp 224,000 Rp 409,700 Rp 336,100 Rp 73,600
    Q-5-44-0 Rp 122,500 Rp 194,700 Rp 194,700 Rp -
    U-3-13-0 Rp 190,200 Rp 409,700 Rp 336,100 Rp 73,600
    M-3-16-0 Rp 60,000 Rp 120,100 - -
    U-3-13-0 Rp 439,700 Rp 409,700 Rp 336,100 Rp 73,600
    U-3-13-0 Rp 144,000 Rp 409,700 Rp 336,100 Rp 73,600
    L-3-12-0 Rp 167,500 Rp 219,800 Rp 219,800 Rp -
    Q-5-44-0 Rp 148,000 Rp 310,800 Rp 194,700 Rp 116,100
    U-3-13-0 Rp 171,500 Rp 409,700 Rp 336,100 Rp 73,600
    U-3-13-0 Rp 209,200 Rp 409,700 Rp 336,100 Rp 73,600
    U-3-13-0 Rp 157,700 Rp 409,700 Rp 336,100 Rp 73,600
    U-3-13-0 Rp 171,700 Rp 409,700 Rp 336,100 Rp 73,600
    Q-5-44-0 Rp 95,000 Rp 194,700 Rp 194,700 Rp -
    Q-5-44-0 Rp 130,000 Rp 194,700 - -
    U-3-13-0 Rp 184,000 Rp 409,700 Rp 336,100 Rp 73,600
    U-3-13-0 Rp 286,500 Rp 409,700 Rp 336,100 Rp 73,600
    Z-3-25-0 Rp 183,000 Rp 599,600 Rp 335,100 Rp 264,500
    Z-3-25-0 Rp 223,000 Rp 335,100 Rp 335,100 Rp -
    U-3-15-0 Rp 137,100 Rp 319,500 Rp 269,500 Rp 50,000
    U-3-13-0 Rp 140,200 Rp 409,700 Rp 336,100 Rp 73,600
    U-3-13-0 Rp 140,200 Rp 409,700 Rp 336,100 Rp 73,600
    U-3-13-0 Rp 179,200 Rp 409,700 Rp 336,100 Rp 73,600
    U-3-13-0 Rp 268,500 Rp 409,700 Rp 336,100 Rp 73,600
    U-3-13-0 Rp 168,000 Rp 409,700 Rp 336,100 Rp 73,600
    U-3-13-0 Rp 208,000 Rp 409,700 Rp 336,100 Rp 73,600
    U-3-13-0 Rp 168,700 Rp 409,700 Rp 336,100 Rp 73,600
    U-3-13-0 Rp 210,500 Rp 409,700 Rp 336,100 Rp 73,600
    U-3-13-0 Rp 188,000 Rp 409,700 Rp 336,100 Rp 73,600
    Q-5-18-0 Rp 85,000 Rp 151,100 Rp 151,100 Rp -
    Q-5-44-0 Rp 300,500 Rp 194,700 - -
    Rp 15,336,594 Rp 28,802,300 Rp 23,686,900 Rp 4,301,100
    Petugas BPJS

    MAYYANE
    keterangan

    dx tindakan
    dx tindakan
    dx tindakan
    dx utama
    konfirm SIP
    konfirm SIP
    konfirm SIP
    1 episode dngn tgl 31/10/2016
    konfirm px JR (Jasa Raharja)
    konfirm RHM
    dx tindakan
    konfirm SIP
    konfirm SIP
    konfirm SIP
    dx tindakan
    dx tindakan
    salah SEP
    dx utama
    dx tindakan
    dx tindakan
    berkas sisipan
    dx tindakan
    dx tindakan
    dx tdk sesuai
    dx tindakan
    dx tindakan
    dx tindakan
    dx tindakan
    dx tindakan
    dx tindakan
    salah SEP
    konfirm dx
    konfirm KLL
    dx utama
    dx tindakan
    dx tindakan
    dx tindakan
    dx tindakan
    dx tindakan
    dx tindakan
    dx tindakan
    dx tindakan
    dx tindakan
    dx tindakan
    dx tindakan
    dx tindakan
    dx tindakan
    1 episode dngn tgl 14/11/2016
    dx tindakan
    dx tindakan
    dx tindakan
    dx tindakan
    berkas sisipan
    dx tindakan
    dx tindakan
    vitiligo tidak dijamin
    dx tindakan
    berkas sisipan
    dx tindakan
    dx tindakan
    konfirm KLL
    dx utama
    dx tindakan
    dx tindakan
    dx tindakan
    dx tindakan
    konfirm dx
    berkas sisipan
    dx tindakan
    dx tindakan
    konfirm USG
    1 episode ranap
    dx tindakan
    dx tindakan
    dx tindakan
    dx tindakan
    dx tindakan
    dx tindakan
    dx tindakan
    dx tindakan
    dx tindakan
    dx tindakan
    skrinning (tidak dijamin)
    berkas tidak ada

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