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  • BPJS Kesehatan Cab. PALU: P1905000032735 Provider Nomor FPK Tomini Bulan Pelayanan Pelayanan RJTP May 2019

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    BPJS Kesehatan Cab. PALU provided feedback on a claim submission from TOMINI provider for medical services in May 2019. The verification showed 40 transactions totaling Rp 8,026,000 were approved. Details included patient names, dates of admission and discharge, costs, and confirmation of approval status for each claim. The feedback was issued on June 20, 2019.

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    BPJS Kesehatan Cab. PALU provided feedback on a claim submission from TOMINI provider for medical services in May 2019. The verification showed 40 transactions totaling Rp 8,026,000 were approved. Details included patient names, dates of admission and discharge, costs, and confirmation of approval status for each claim. The feedback was issued on June 20, 2019.

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    4 views2 pages

    BPJS Kesehatan Cab. PALU: P1905000032735 Provider Nomor FPK Tomini Bulan Pelayanan Pelayanan RJTP May 2019

    Uploaded by

    sasa
    BPJS Kesehatan Cab. PALU provided feedback on a claim submission from TOMINI provider for medical services in May 2019. The verification showed 40 transactions totaling Rp 8,026,000 were approved. Details included patient names, dates of admission and discharge, costs, and confirmation of approval status for each claim. The feedback was issued on June 20, 2019.

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    BPJS Kesehatan Cab.

    PALU
    UMPAN BALIK VERIFIKASI
    PENGAJUAN KLAIM TINGKAT PERTAMA

    Nomor FPK : P1905000032735

    Provider : TOMINI

    Bulan Pelayanan : May 2019

    Pelayanan : RJTP

    Pelayanan Verifikasi

    Total Data : 40 Total Data : 40

    Total Tagihan : Rp. 8.026.000 Total Tagihan : Rp. 8.026.000

    NO TRANSAKSI NAMA PESERTA TGL MASUK TGL PULANG BIAYA STAT KETERANGAN

    200906010519P000014 MOH. RIKAL (0000919396225) 07/05/2019 07/05/2019 Rp. 240.000 Setuju

    200906010519P000015 TO`U (0000919881347) 07/05/2019 07/05/2019 Rp. 240.000 Setuju

    200906010519P000031 ANIYA (0000918877263) 02/05/2019 02/05/2019 Rp. 200.000 Setuju

    200906010519P000032 ANIYA (0000918877263) 03/05/2019 03/05/2019 Rp. 25.000 Setuju

    200906010519P000034 ENI (0000918831835) 11/05/2019 11/05/2019 Rp. 200.000 Setuju

    200906010519P000035 ENI (0000918831835) 12/05/2019 12/05/2019 Rp. 25.000 Setuju

    200906010519P000037 MASITA (0001567325935) 02/05/2019 02/05/2019 Rp. 200.000 Setuju

    200906010519P000038 MASITA (0001567325935) 03/05/2019 03/05/2019 Rp. 25.000 Setuju

    200906010519P000039 SUMIRNA (0000919522541) 15/05/2019 15/05/2019 Rp. 240.000 Setuju

    200906010519P000041 HASRIA (0000919480768) 16/05/2019 16/05/2019 Rp. 240.000 Setuju

    200906010519P000043 ANDI MAWAR (0000918459112) 17/05/2019 17/05/2019 Rp. 240.000 Setuju

    200906010519P000044 INRIATI, A.MA (0000920002498) 17/05/2019 17/05/2019 Rp. 240.000 Setuju

    200906010519P000143 MASINDAH (0002391830695) 18/05/2019 18/05/2019 Rp. 240.000 Setuju

    200906010519P000183 WANA ELFINA (0000918542946) 15/05/2019 15/05/2019 Rp. 200.000 Setuju

    200906010519P000184 WANA ELFINA (0000918542946) 16/05/2019 16/05/2019 Rp. 25.000 Setuju

    200906010519P000186 MASNIAR (0000919180798) 15/05/2019 15/05/2019 Rp. 200.000 Setuju

    200906010519P000187 MASNIAR (0000919180798) 16/05/2019 16/05/2019 Rp. 25.000 Setuju

    200906010519P000189 NURHAYATI (0000919488655) 06/05/2019 06/05/2019 Rp. 200.000 Setuju

    200906010519P000190 NURHAYATI (0000919488655) 07/05/2019 07/05/2019 Rp. 25.000 Setuju

    200906010519P000192 YULI (0000918462633) 14/05/2019 14/05/2019 Rp. 200.000 Setuju

    200906010519P000193 YULI (0000918462633) 15/05/2019 15/05/2019 Rp. 25.000 Setuju

    200906010519P000195 SRI DEWI (0000919670894) 11/05/2019 11/05/2019 Rp. 200.000 Setuju

    200906010519P000196 SRI DEWI (0000919670894) 12/05/2019 12/05/2019 Rp. 25.000 Setuju

    200906010519P000198 FITRIYANI (0000919564536) 15/05/2019 15/05/2019 Rp. 200.000 Setuju

    200906010519P000199 FITRIYANI (0000919564536) 16/05/2019 16/05/2019 Rp. 25.000 Setuju

    200906010519P000201 MUTMAINA (0000918525745) 08/05/2019 08/05/2019 Rp. 200.000 Setuju

    200906010519P000202 MUTMAINA (0000918525745) 09/05/2019 09/05/2019 Rp. 25.000 Setuju

    200906010519P000204 YANI (0000920299678) 14/05/2019 14/05/2019 Rp. 200.000 Setuju

    200906010519P000205 YANI (0000920299678) 15/05/2019 15/05/2019 Rp. 25.000 Setuju

    200906010519P000207 MINIARTI (0002023675132) 08/05/2019 08/05/2019 Rp. 25.000 Setuju


    NO TRANSAKSI NAMA PESERTA TGL MASUK TGL PULANG BIAYA STAT KETERANGAN

    200906010519P000209 AYU LESTARI (0000919526883) 22/05/2019 22/05/2019 Rp. 200.000 Setuju

    200906010519P000211 IYAMINA (0002391828489) 01/05/2019 01/05/2019 Rp. 200.000 Setuju

    200906010519P000212 IYAMINA (0002391828489) 02/05/2019 02/05/2019 Rp. 25.000 Setuju

    200906010519P000213 NUR LINDA (0000919541812) 14/05/2019 14/05/2019 Rp. 1.218.000 Setuju

    200906010519P000281 MARYAM (0000134767607) 12/05/2019 12/05/2019 Rp. 240.000 Setuju

    200906010519P000282 KONTI (0000919109103) 21/05/2019 21/05/2019 Rp. 240.000 Setuju

    200906010519P000283 RUSMIA (0000919297394) 11/05/2019 11/05/2019 Rp. 240.000 Setuju

    200906010519P000284 RATNI (0000918530943) 19/05/2019 19/05/2019 Rp. 240.000 Setuju

    200906010519P000319 AYU LESTARI (0000919526883) 23/05/2019 23/05/2019 Rp. 25.000 Setuju

    200906010519P000320 INDOCENA (0002249300474) 08/05/2019 08/05/2019 Rp. 1.218.000 Setuju

    Tanggal, 20/06/2019
    Tanggal terima FPK,
    Pengaju Klaim
    Verifikator

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