Scribd Logo
Upload

Welcome to Scribd!

  • BPJS Kesehatan Cab. SURAKARTA

    Uploaded by

    Eko Jayanti
    2 views2 pages
    The document is a verification report from BPJS Kesehatan Cab. SURAKARTA for a claim submission. It details 33 promotional healthcare services provided by Mondokan in February 2019, listing the patient names and details of each transaction. All 33 claims with a total cost of Rp. 660,000 were verified and approved.

    Original Description:

    bpjs

    Original Title

    bpjs

    Copyright

    © © All Rights Reserved

    Available Formats

    PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    Report this Document
    The document is a verification report from BPJS Kesehatan Cab. SURAKARTA for a claim submission. It details 33 promotional healthcare services provided by Mondokan in February 2019, listing the patient names and details of each transaction. All 33 claims with a total cost of Rp. 660,000 were verified and approved.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    2 views2 pages

    BPJS Kesehatan Cab. SURAKARTA

    Uploaded by

    Eko Jayanti
    The document is a verification report from BPJS Kesehatan Cab. SURAKARTA for a claim submission. It details 33 promotional healthcare services provided by Mondokan in February 2019, listing the patient names and details of each transaction. All 33 claims with a total cost of Rp. 660,000 were verified and approved.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    of 2

    BPJS Kesehatan Cab.

    SURAKARTA
    UMPAN BALIK VERIFIKASI
    PENGAJUAN KLAIM TINGKAT PERTAMA

    Nomor FPK : P1902000043730

    Provider : Mondokan

    Bulan Pelayanan : February 2019

    Pelayanan : Promotif

    Pelayanan Verifikasi

    Total Data : 33 Total Data : 33

    Total Tagihan : Rp. 660.000 Total Tagihan : Rp. 660.000

    NO TRANSAKSI NAMA PESERTA TGL MASUK TGL PULANG BIAYA STAT KETERANGAN

    112616010219P000570 SUPARTI (0000090239499) 22/02/2019 22/02/2019 Rp. 20.000 Setuju

    112616010219P000618 SITI KUDIMAH (0001452186999) 22/02/2019 22/02/2019 Rp. 20.000 Setuju

    112616010219P000619 SUNARTI (0000090531707) 22/02/2019 22/02/2019 Rp. 20.000 Setuju

    112616010219P000620 INTARTI (0000149351916) 22/02/2019 22/02/2019 Rp. 20.000 Setuju

    112616010219P000621 SIRADNO (0000090812867) 22/02/2019 22/02/2019 Rp. 20.000 Setuju

    112616010219P000622 SULASMI (0000090563589) 22/02/2019 22/02/2019 Rp. 20.000 Setuju

    112616010219P000623 KINEM (0000573981952) 22/02/2019 22/02/2019 Rp. 20.000 Setuju

    112616010219P000624 PARNI (0000573948887) 22/02/2019 22/02/2019 Rp. 20.000 Setuju

    112616010219P000625 HARNI (0000572312777) 22/02/2019 22/02/2019 Rp. 20.000 Setuju

    112616010219P000626 PAndi (0001893920117) 22/02/2019 22/02/2019 Rp. 20.000 Setuju

    112616010219P000627 SULASTRI (0000573795033) 22/02/2019 22/02/2019 Rp. 20.000 Setuju

    112616010219P000628 KASIYEM (0000572185844) 22/02/2019 22/02/2019 Rp. 20.000 Setuju

    112616010219P000630 TUMIRAH (0000572725438) 22/02/2019 22/02/2019 Rp. 20.000 Setuju

    112616010219P000631 SUNARTO (0000090339028) 22/02/2019 22/02/2019 Rp. 20.000 Setuju

    112616010219P000632 PARTI (0000573634754) 22/02/2019 22/02/2019 Rp. 20.000 Setuju

    112616010219P000633 DIKDO SUWARNO (0000571886537) 22/02/2019 22/02/2019 Rp. 20.000 Setuju

    112616010219P000634 SRI NURYATI (0002291794165) 22/02/2019 22/02/2019 Rp. 20.000 Setuju

    112616010219P000635 SITI FATIMAH (0000090336521) 22/02/2019 22/02/2019 Rp. 20.000 Setuju

    112616010219P000637 SAJEM (0000572321261) 22/02/2019 22/02/2019 Rp. 20.000 Setuju

    112616010219P000638 WADI SISWO WIYONO (0000572703794) 22/02/2019 22/02/2019 Rp. 20.000 Setuju

    112616010219P000639 GIYARTI (0000572443154) 22/02/2019 22/02/2019 Rp. 20.000 Setuju

    112616010219P000640 PARTI (0000572352974) 22/02/2019 22/02/2019 Rp. 20.000 Setuju

    112616010219P000641 SURATI (0001022631287) 22/02/2019 22/02/2019 Rp. 20.000 Setuju

    112616010219P000643 NGATINAH (0000573323523) 22/02/2019 22/02/2019 Rp. 20.000 Setuju

    112616010219P000644 SUMINEM (0002310078993) 22/02/2019 22/02/2019 Rp. 20.000 Setuju

    112616010219P000645 SARDIYANTO (0001697336752) 22/02/2019 22/02/2019 Rp. 20.000 Setuju

    112616010219P000646 WARDI (0000090738707) 22/02/2019 22/02/2019 Rp. 20.000 Setuju

    112616010219P000647 SRI NURYANI (0000090701256) 22/02/2019 22/02/2019 Rp. 20.000 Setuju

    112616010219P000648 SITI BAROKATI (0000572403767) 22/02/2019 22/02/2019 Rp. 20.000 Setuju

    112616010219P000649 SYAMSIYAH (0000090624227) 22/02/2019 22/02/2019 Rp. 20.000 Setuju


    NO TRANSAKSI NAMA PESERTA TGL MASUK TGL PULANG BIAYA STAT KETERANGAN

    112616010219P000650 MULYANI (0000573392259) 22/02/2019 22/02/2019 Rp. 20.000 Setuju

    112616010219P000651 REBIYANTI (0000210646776) 22/02/2019 22/02/2019 Rp. 20.000 Setuju

    112616010219P000652 PANEM (0001091950514) 22/02/2019 22/02/2019 Rp. 20.000 Setuju

    Tanggal, 13/06/2019
    Tanggal terima FPK,
    Pengaju Klaim
    Verifikator

    You might also like