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  • UmpanBalik IF RS EMC PULOMAS ORJTL MARET 2022 REG 749 REV4

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    Iebeth Utan
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    This document is a feedback report from IF RS EMC Pulomas hospital on the results of a claim verification for services provided in March 2022. It details 27 cases where the claimed costs and approved costs did not match. The total claimed cost was Rp19.96 billion while the total approved cost was Rp16.05 billion, resulting in a difference of Rp3.91 billion. The provider and Mandiri Inhealth verified the costs and approved the report on July 14, 2022.

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    This document is a feedback report from IF RS EMC Pulomas hospital on the results of a claim verification for services provided in March 2022. It details 27 cases where the claimed costs and approved costs did not match. The total claimed cost was Rp19.96 billion while the total approved cost was Rp16.05 billion, resulting in a difference of Rp3.91 billion. The provider and Mandiri Inhealth verified the costs and approved the report on July 14, 2022.

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    14 views2 pages

    UmpanBalik IF RS EMC PULOMAS ORJTL MARET 2022 REG 749 REV4

    Uploaded by

    Iebeth Utan
    This document is a feedback report from IF RS EMC Pulomas hospital on the results of a claim verification for services provided in March 2022. It details 27 cases where the claimed costs and approved costs did not match. The total claimed cost was Rp19.96 billion while the total approved cost was Rp16.05 billion, resulting in a difference of Rp3.91 billion. The provider and Mandiri Inhealth verified the costs and approved the report on July 14, 2022.

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    of 2

    PT.

    ASURANSI JIWA INHEALTH INDONESIA


    UMPAN BALIK HASIL VERIFIKASI

    NAMA PROVIDER : IF RS EMC PULOMAS

    TINGKAT PELAYANAN : RJTL

    BULAN PELAYANAN : Mar 2022

    NO FPK RS : 0903A020042202

    NO INVOICE PROVIDER : 18 389

    Data SJP yang memiliki selisih :

    No No SJP Tanggal SJP Tanggal Verifikasi Biaya Keterangan

    Diajukan Disetujui

    1 0903A0200422X000161 01 Mar 2022 25 Apr 2022 538,834 533,557

    2 0903A0200422X000164 01 Mar 2022 25 Apr 2022 1,533 0

    3 0903A0200422X000169 01 Mar 2022 25 Apr 2022 2,395,337 1,888,277

    4 0903A0200422X000170 01 Mar 2022 25 Apr 2022 779,200 757,378

    5 0903A0200422X000079 04 Mar 2022 13 Jun 2022 373,128 356,496

    6 0903A0200422X000147 05 Mar 2022 04 Jul 2022 317,131 313,831

    7 0903A0200422X000150 05 Mar 2022 13 Jun 2022 256,536 249,556

    8 0903A0200422X000155 05 Mar 2022 25 Apr 2022 526,301 521,209

    9 0903A0200422X000136 09 Mar 2022 25 Apr 2022 86,550 45,062

    10 0903A0200422X000137 09 Mar 2022 12 Jul 2022 189,070 176,262

    11 0903A0200422X000129 10 Mar 2022 04 Jul 2022 768,598 229,764

    12 0903A0200422X000081 11 Mar 2022 25 Apr 2022 1,272,264 575,989

    13 0903A0200422X000127 11 Mar 2022 25 Apr 2022 86,550 45,062

    14 0903A0200422X000092 12 Mar 2022 25 Apr 2022 1,122,924 0

    15 0903A0200422X000103 15 Mar 2022 25 Apr 2022 74,991 63,332

    PelayananOnline; printed at 14 Jul 2022 10:08:44 - 0901O042200749 - page 1 of 2;


    16 0903A0200422X000104 15 Mar 2022 25 Apr 2022 1,127,820 1,098,660

    17 0903A0200422X000101 17 Mar 2022 04 Jul 2022 102,408 71,526

    18 0903A0200422X000096 19 Mar 2022 25 Apr 2022 251,148 249,525

    19 0903A0200422X000035 21 Mar 2022 25 Apr 2022 2,020,226 1,898,123

    20 0903A0200422X000073 23 Mar 2022 26 Apr 2022 107,510 106,855

    21 0903A0200422X000067 24 Mar 2022 25 Apr 2022 229,831 225,907

    22 0903A0200422X000068 24 Mar 2022 25 Apr 2022 296,452 291,995

    23 0903A0200422X000057 28 Mar 2022 26 Apr 2022 408,653 0

    24 0903A0200422X000044 29 Mar 2022 26 Apr 2022 117,600 107,312

    25 0903A0200422X000050 30 Mar 2022 14 Jul 2022 5,492,928 5,439,554

    26 0903A0200422X000026 31 Mar 2022 26 Apr 2022 810,520 806,334

    27 0903A0200422X000027 31 Mar 2022 26 Apr 2022 206,578 0

    Total 19,960,621 16,051,566

    Resume Kasus Biaya

    Total Biaya Diajukan 145 45.705.068

    Total Biaya Disetujui 145 41.796.013

    Selisih 3.909.055

    Menyetujui, Mengetahui, Jakarta Pusat, 14-Jul-2022


    Provider Kepala Unit Mandiri Inhealth Verifikator Mandiri Inhealth

    ............................ Johan Syahroni Nanik Trisnowati

    PelayananOnline; printed at 14 Jul 2022 10:08:44 - 0901O042200749 - page 2 of 2;

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