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  • CreatePDF - 2022-04-13T074402.141

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    Silfa Riany
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    7 views1 page

    CreatePDF - 2022-04-13T074402.141

    Uploaded by

    Silfa Riany

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    of 1

    BPJS Kesehatan Cab.

    BANDAR LAMPUNG
    UMPAN BALIK VERIFIKASI
    PENGAJUAN KLAIM TINGKAT PERTAMA

    Nomor FPK : P2203000016377

    Provider : MEYLENA TARSINI

    Bulan Pelayanan : March 2022

    Pelayanan : RITP

    Pelayanan Verifikasi

    Total Data : 1 Total Data : 1 Layak : 1 Tidak Layak : 0

    Total Tagihan : Rp. 700.000 Total Tagihan : Rp. 700.000 Pending : 0 DIspute : 0

    NO TRANSAKSI NAMA PESERTA TGL MASUK TGL PULANG BIAYA STAT KETERANGAN

    B00058370322P000001 DEPI YANTI (0001797605605) 17/03/2022 18/03/2022 Rp. 700.000 Layak

    Tanggal, 13/04/2022
    Tanggal terima FPK,
    Pengaju Klaim
    Verifikator

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