BPJS Kesehatan Cab.

BUKIT TINGGI
UMPAN BALIK VERIFIKASI
PENGAJUAN KLAIM TINGKAT PERTAMA

Nomor FPK : P1906000051433

Provider : LADANG PANJANG

Bulan Pelayanan : June 2019

Pelayanan : RITP

Pelayanan Verifikasi

Total Data : 18 Total Data : 0 Layak : 17 Tidak Layak : 0

Total Tagihan : Rp. 12.100.000 Total Tagihan : Rp. 0 Pending : 0 DIspute : 0

NO TRANSAKSI NAMA PESERTA TGL MASUK TGL PULANG BIAYA STAT KETERANGAN

031401020619P000619 DALISMAR (0000279442844) 02/06/2019 03/06/2019 Rp. 700.000 Layak

031401020619P000620 NORPITA (0000278658224) 02/06/2019 03/06/2019 Rp. 700.000 Layak

031401020619P000621 ASMA DEWITA (0002741694232) 02/06/2019 03/06/2019 Rp. 700.000 Layak

031401020619P000634 ANIS (0001504727638) 13/06/2019 14/06/2019 Rp. 700.000 Layak

031401020619P000636 YENTI (0000278363496) 13/06/2019 14/06/2019 Rp. 700.000 Layak

031401020619P000638 WARNI (0001504673662) 06/06/2019 07/06/2019 Rp. 700.000 Layak

031401020619P000639 JUSNIMAR (0000278761296) 11/06/2019 21/06/2019 Rp. 700.000 Layak

031401020619P001063 MURNI SANTIKA (0000279447579) 23/06/2019 24/06/2019 Rp. 700.000 Layak

031401020619P001064 SINET (0000278892336) 18/06/2019 19/06/2019 Rp. 700.000 Layak

031401020619P001065 HERLINA MARDELI (0000278115401) 02/06/2019 03/06/2019 Rp. 200.000 Baru

031401020619P001115 SUMIYATI (0000276948516) 11/06/2019 29/06/2019 Rp. 700.000 Layak

031401020619P001202 MIRA YUSNITA (0001504731633) 04/06/2019 05/06/2019 Rp. 700.000 Layak

031401020619P001205 MARTINIS (0001684245317) 03/06/2019 04/06/2019 Rp. 700.000 Layak

031401020619P001206 FATMAWATI (0002115059253) 12/06/2019 13/06/2019 Rp. 700.000 Layak

031401020619P001208 SILEN (0000279942467) 11/06/2019 12/06/2019 Rp. 700.000 Layak

031401020619P001213 SIREK (0001504732274) 16/06/2019 17/06/2019 Rp. 700.000 Layak

031401020619P001222 KAMINAR (0000279023534) 03/06/2019 03/06/2019 Rp. 700.000 Layak

031401020619P001230 ERNI (0001504729192) 05/06/2019 06/06/2019 Rp. 700.000 Layak

Tanggal, 28/10/2019
Tanggal terima FPK,
Pengaju Klaim
Verifikator