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ASSIGN TO DAY STATUS ICD DESCRIPTION CARD NO

CXFARA 7 23 B34.2 Coronavirus infection, unsp 8000210116982784


IS_AXVE 5 23 K29.7 GASTRITIS 8000210117952018
IS_AXDIA 5 23 A09 Diarrhoea and Gastroenterit8000210119358354
EXCORY2 5 23 M41 Scoliosis 8000210110969118
IS_KXNI 5 23 8000210119087649
IS_XXAS 5 23 A09 Diarrhoea and Gastroenterit8000210116646595
IS_AXVE 4 23 K30 Dyspepsia 8000210117302693
IS_AXVE 4 23 A09 Diarrhoea and Gastroenterit8000210115104950
IS_AXDIA 4 23 M48 Other spondylopathies 8000210113610750
IS_KXNI 4 23 M51.2 Other Specified Interverteb 8000210116424043
IS_KXNI 4 23 I25.1 CORONARY ATRIAL DISE 8000210117778587
EXCORY2 4 23 G81 Hemiplegia 8000210115347443
EXCORY2 4 23 K30 Dyspepsia 8000210116495787
IS_AXDIA 3 23 B34.2 Coronavirus infection, unsp 8000210118066966
IS_AXDIA 3 23 K30 Dyspepsia 8000210118431814
IS_AXVE 3 23 R51 Headache ( Cephalgia) 8000210119370268
IS_XXAS 3 23 R11 Nausea and Vomiting (mual8000210116958503
IS_KXNI 3 23 T14 Injury of Unspecified body 8000210118859113
IS_KXNI 3 23 K30 Dyspepsia 8000210118734902
IS_KXNI 3 23 K30 Dyspepsia 8000210116123041
EXCORY2 3 23 K30 Dyspepsia 8000210117730554
EXCORY2 3 23 I64 Stroke not specified as hae 8000210118454568
EXCORY2 3 23 K30 Dyspepsia 8000210119476503
CXFARA 3 23 M19 OTHER ARTHROSIS 8000210119683637
IS_AXDIA 3 23 R50 Fever of Unknown origin 8000210119059499
IS_AXVE 2 23 B34.2 Coronavirus infection, unsp 8000210116644749
IS_XXAS 2 23 B34.2 Coronavirus infection, unsp 8000210116784586
IS_AXVE 2 23 A91 Dengue Haemorrhagic Feve8000210114506387
IS_AXVE 2 23 R51 Headache ( Cephalgia) 8000210111230874
IS_XXAS 2 23 A09 Diarrhoea and Gastroenterit8000210116831759
IS_AXDIA 2 23 R50.9 Fever 8000210116629617
IS_AXVE 2 23 A90 DENGUE FEVER 8000210117701688
IS_AXVE 2 23 I10 ESSENTIAL (PRIMARY) 8000210118184769
IS_AXVE 2 23 I25 Chronic Ischaemic Heart D 8000210105135543
IS_AXDIA 2 23 R50 Fever of Unknown origin 8000210117441228
IS_KXNI 2 23 A09 Diarrhoea and Gastroenterit8000210118105343
IS_KXNI 2 23 R60.9 OEDEMA- UNSPECIFIED 8000210117957827
IS_KXNI 2 23 A09 Diarrhoea and Gastroenterit8000210119345708
IS_KXNI 2 23 R10 Abdominal and pelvic pain 8000210119114625
IS_KXNI 2 23 N39 OTHER DISORDERS OF U8000210118180767
EXCORY2 2 23 T63.0 Snake venom 8000210116763697
IS_AXDIA 2 23 K30 Dyspepsia 8000210116828011
EXCORY2 2 23 K30 Dyspepsia 8000210118729605
EXCORY2 2 23 K80 Cholelithiasis 8000210116507797
EXCORY2 2 23 J20 Acute Bronchitis 8000210116743731
EXCORY2 2 23 R50.9 Fever 8000210119063897
CXFARA 2 23 R50 Fever of Unknown origin 8000210118964202
IS_AXDIA 2 23 B34.2 Coronavirus infection, unsp 8000210116584630
IS_AXDIA 2 23 R51 Headache ( Cephalgia) 8000210119334793
IS_AXVE 1 23 R50.9 Fever 8000210118083698
IS_AXVE 1 23 H81 Disorders of vestibular func 8000210111005417
IS_XXAS 1 23 R50.9 Fever 8000210119091559
IS_XXAS 1 23 8000210119030292
IS_AXVE 1 23 R10 Abdominal and pelvic pain 8000210119149522
IS_XXAS 1 23 8000210115052118
IS_XXAS 1 23 8000210117150787
IS_AXVE 1 23 A09 Diarrhoea and Gastroenterit8000210114792250
IS_XXAS 1 23 8000210119496832
IS_KXNI 1 23 8000210118937679
IS_KXNI 1 23 T79.4 Traumatic shock 8000210111298624
IS_AXVE 1 23 R50.9 Fever 8000210116188309
IS_AXVE 1 23 A91 Dengue Haemorrhagic Feve8000210118343985
IS_AXVE 1 23 A90 DENGUE FEVER 8000210119571014
IS_AXVE 1 23 J45 Asthma 8000210117748705
IS_AXVE 1 23 8000210118854577
IS_KXNI 1 23 R50.9 Fever 8000210118121746
IS_KXNI 1 23 S02.4 Fracture of malar and maxil 8000210111209969
IS_KXNI 1 23 G45.9 Transient cerebral ischaemi8000210118182706
IS_KXNI 1 23 8000210119528527
IS_KXNI 1 23 R10 Abdominal and pelvic pain 8000210117248565
IS_KXNI 1 23 A91 Dengue Haemorrhagic Feve8000210116435726
EXCORY2 1 23 E11 NON-INSULIN-DEPENDEN8000210110660568
CXFARA 1 23 M50.2 OTHER CERVICAL DISC 8000210117713402
CXFARA 1 23 R10.0 Acute Abdomen 8000210114163320
CXFARA 1 23 A90 DENGUE FEVER 8000210118088317
CXFARA 1 23 C50 MALIGNANT NEOPLASM 8000210115499822
CXFARA 1 23 R51 Headache ( Cephalgia) 8000210118943420
CXFARA 1 23 R50.9 Fever 8000210118132941
IS_AXDIA 1 23 B34.2 Coronavirus infection, unsp 8000210118887213
IS_AXDIA 1 23 8000210118057429
IS_AXDIA 1 23 B34.2 Coronavirus infection, unsp 8000210117360360
IS_AXDIA 1 23 I63 Cerebral Infarction 8000210118712072
IS_AXDIA 1 23 B34.9 Viral infection 8000210112948375
IS_AXDIA 1 23 N34 Urethritis and urethral syn 8000210113122996
IS_AXDIA 1 23 R11 Nausea and Vomiting (mual8000210119758652
IS_AXDIA 1 23 N45 Orchitis and Epididymitis 8000210114394578
IS_AXDIA 1 23 R50.9 Fever 8000210117339364
EXCORY2 1 23 R11 Nausea and Vomiting (mual8000210117695393
EXCORY2 1 23 R50.9 Fever 8000210118684511
EXCORY2 1 23 R50.9 Fever 8000210117098523
EXCORY2 1 23 R10 Abdominal and pelvic pain 8000210118175981
EXCORY2 1 23 K51 Ulcerative colitis 8000210119603155
EXCORY2 1 23 K30 Dyspepsia 8000210119502761
EXCORY2 1 23 R10 Abdominal and pelvic pain 8000210116984277
EXCORY2 1 23 K30 Dyspepsia 8000210119473971
ASRINT 0 23 N18 Chronic Renal Failure (CR 8000210117612794
IS_SXSIT 0 23 A91 Dengue Haemorrhagic Feve8000210113020018
XXSENI 0 23 C50 MALIGNANT NEOPLASM 8000210118894797
IS_SXSIT 0 23 I64 Stroke not specified as hae 8000210117505204
ASRINT 0 23 H81.1 Benign paroxysmal vertigo 8000210115758342
ASRINT 0 23 T14 Injury of Unspecified body 8000210118809886
ASRINT 0 23 S83.5 Sprain and strain involving 8000210116672211
TINA 0 23 R10 Abdominal and pelvic pain 8000210118714862
IS_SXSIT 0 23 A09 Diarrhoea and Gastroenterit8000210118605110
IS_SXSIT 0 23 R10 Abdominal and pelvic pain 8000210112652936
IS_SXSIT 0 23 J02 Acute Pharyngitis 8000210116841717
PATIENT NAME PROVIDER COPRORATE POLICY NO MEMBER ID
LILY SUSANTO RS. BUDI RAHAYU PEKALO HS CARE PREMIER XTRA - O563 000062749480
BARITA FIRMAN BGEA RS. SANTO ANTONIUS HS PON CARE PREMIER XTRA - O411 000065491241
MOHAMMAD ANWAR RS. TIARA BEKASI (IDR)HOSPITAL & SURGICAL CAO747 000069479779
MICHELLE AUDREY MI EKA HOSPITAL BSD (IDR) H&S INDIVIDU - H&S_IND O014 000038810743
SILVIA NATALIA MRCCC-SILOAM HOSPITALS HOSPITAL & SURGICAL CAO693 000068533963
LUH PUTU SHANIA LUSRS. ANNA PEKAYON (IDR) 2000000000 HS CARE PREMIER XTRA-HSCPX_IND
ELFRINAWATI PURBA MURNI TEGUH MEMORIAL HS CAREH PREMIER XTRA - O641 000063603463
LUCIANA BETHSAIDA HOSPITAL HOSPITAL
(IDR & SURGICAL CAO472 000058589670
ARIES KRISNANDARI RSPAD GATOT SUBROTO H&SR1PA INDIVIDU - H&SR1_ O322 000053602467
AGUS LIMANTO RS. ST.CAROLUS (IDR) HS - CARE PREMIER XTRA - O428 000061814534
SYAMSUL MAARIF RS. EMC PULOMAS (IDR) HS CARE PREMIER XTRA - O744 000065034449
MULJANTO WIROTAN RS. MITRA KELUARGA 999999999
TEGA HS OPTION AGE-H&SO_IND
SUN HOK RS. SANTO ANTONIUS 2975082548
PON HS CARE PREMIER XTRA-HSCPX_IND
IVAN YIO RS. ROYAL PRIMA MEDAN HS CARE( PREMIER XTRA - O491 000040055123
AMELIA KRISTANTI SA MITRA KELUARGA KALIDER HOSPITAL & SURGICAL CAO531 000066734887
YULIANI OFTARA RS. JIH (SOLO) (IDR) - 8
HOSPITAL & SURGICAL CAO750 000069527908
JONY RS. COLUMBIA ASIA MEDANHS CARE PREMIER XTRA - O611 000058953091
RENDY JULIANTO MAYAPADA HOSPITAL SMARTTANG HEALTH CARE PLUVO37 790300119200
FITRI HANDAYANI RSU. UMMI BENGKULUHOSPITAL
(IDR & SURGICAL CAO605 000067503818
ALDO JAMALUDIN MAYAPADA HOSPITAL HS TANG OPTION AGE - H&SO_I O319 000061103828
FENDY WIONDY RS. AWAL BROS MAKASSAR 5000000000 HS CARE PREMIER XTRA-HSCPX_IND
RONALDO SUSANTO RS. MITRA MEDIKA PONTIA 2000000000 HS CARE PREMIER XTRA-HSCPX_IND
FELIA MINAMI SUGIRI RS. BRAWIJAYA SAHARJO 9992714388
( HOSPITAL & SURGICAL CARE PREMIER PL
IDA SILOAM HOSPITALS KEBON 7000000000 HOSPITAL & SURGICAL CARE PREMIER PL
ALFRED ALBERT TUW RS. EMC ALAM SUTERA14000000000
(ID HOSPITAL & SURGICAL CARE PREMIER PL
FEBY ESTER CAROLIN RS. EMC ALAM SUTERAHOSPITAL(ID & SURGICAL CAO487 000057061763
JOURDAN PHILLIP DANRS. HERMINA KEMAYORAN HS CARE PREMIER XTRA - O522 000062631411
JUVINA TANASIA MURNI TEGUH MEMORIAL H&SR1 H INDIVIDU - H&SR1_ O278 000056726397
VIVI LOVIANA SILOAM HOSPITALS LIPPO H&S INDIVIDU - H&S_IND O064 000039740063
GOEI HENRY KRISTIY RS. CIPUTRA CITRA GARDE HS CARE PREMIER XTRA - O539 000062715345
HERDANTYO REVAN N RS. EMC PEKAYON (IDR) HS CARE PREMIER XTRA - O478 000062308738
ERWIN TANUMIDJAJA RS. MITRA KELUARGA HS KENCARE PREMIER XTRA - O411 000058802861
RICCO APRILRIES RS. PANTAI INDAH KAPUK HS CARE PREMIER XTRA - O473 000066124495
LEO CHRISTIAN RS. DR. OEN SOLO BARU ALLIANZ
( INDIVIDU - INDIVI V152 LEOCR-00000
MALIK SALMAN AL FARRS. EMC PEKAYON (IDR) HS CARE PREMIER XTRA - O672 000064098106
ERNA RURY ANTAMENRS. MEILIA (IDR) - 1085HS CARE PREMIER XTRA - O455 000065608285
H.ANGGA NUGRAHA N RS. SANTO BORROMEUS HS BA CARE PREMIER XTRA - O412 000065505240
SHEEHAN IRSYAD LIE RSIA. BUNDA ALIYAH (IDR)HS CARE PREMIER XTRA - O744 000069443102
IRENE LIMIN SILOAM HOSPITALS DHIRG HOSPITAL & SURGICAL CAO700 000068706901
KANENI RS. MITRA KELUARGA HS TEGA CARE PREMIER XTRA - O475 000066144163
BERNARDUS VIDIANT RS. PANTAI INDAH KAPUK HS CARE PREMIER XTRA - O519 000062599382
CATRINE SURYADI EKA HOSPITAL BEKASIHS (IDCARE PREMIER XTRA - O536 000062701653
CALVIN OCTAVIANUS RS. HERMINA KEMAYORAN 2000000000 HS CARE PREMIER XTRA-HSCPX_IND
NELLY SILOAM HOSPITALS DHIRG
3000000000 HS CARE PREMIER XTRA-HSCPX_IND
DARIUS WIJAYA EKA HOSPITAL PEKANBARU
4993700857 HS CARE PREMIER XTRA-HSCPX_IND
IVANA EKASANTHI HELRS. TELOGOREJO (IDR)14000000000
- HOSPITAL & SURGICAL CARE PREMIER PL
TRISHA MERY YOCELI SILOAM HOSPITALS PALAN
5000000000 HOSPITAL & SURGICAL CARE PREMIER PL
GWEN FREDELLA KUMRS. EMC ALAM SUTERA1500000000
(ID HOSPITAL & SURGICAL CARE PREMIER-HS
LISA MANDAYA ROYAL HOSPITAL
10000000000 HOSPITAL & SURGICAL CARE PREMIER PL
EDGAR TILAKA RATNA RS. EMC PULOMAS (IDR)HS CARE PREMIER XTRA - O448 000065741414
ESTHER H. SITUMEAN EKA HOSPITAL BSD (IDR)
H&S INDIVIDU - H&S_IND O021 000038903773
KRISTOFORUS ERLANDRS. ST ELISABETH - MEDA
HS CARE PREMIER XTRA - O695 000068572052
RUSNITA BR SINAGA ROYAL PROGRESS INTERN HS CARE PREMIER XTRA - O676 000068332572
VELLYCIA MAUREEN SILOAM HOSPITALS DHIRG HOSPITAL & SURGICAL CAO706 000068824640
EKA NAZWA VERISKA NRS. MITRA BANGSA (IDR)
H&SR1 INDIVIDU - H&SR1_ O057 000058444470
ANNISA DINA HARYADIEKA HOSPITAL BSD (IDR)
HS CARE PREMIER XTRA - O604 000063314350
RIESKY NUGRAHA RS. ADVENT MEDAN (IDR)
HS OPTION AGE - H&SO_I O353 000057671185
AUDREY FRAULEN RS. MITRA KELUARGA HSTEGA OPTION AGE - H&SO_I O362 000069729212
HENNY CHANDRA RS. PANTAI INDAH KAPUK
HS CARE PREMIER XTRA - O693 000052934052
TANIA MURSALIM RS. CIPUTRA CITRA GARDE
GUDANG GARAM TBK. PT -F113 GUGAR-03600
EIBEN HAEZER HANS SMAYAPADA HOSPITAL HS TANG CARE PREMIER XTRA - O733 000061246633
ILHAM TARIGAN RS. HARUM SISMA MEDIKA
INDONESIA EXIMBANK-GRO N108 LPEIN-00100
NI KETUT WIDI ASIH SILOAM HOSPITALS BALIHOSPITAL
( & SURGICAL CAO407 000069886732
FELOVE MARTHA PUTRRS. SENTRA MEDIKA INTEHS CARE PREMIER XTRA - O739 000064982903
NOVIA ANJANI RS. MITRA KELUARGA HOSPITAL
PRA & SURGICAL CAO634 000067822675
AGI DAVID MALEM PERRS. COLUMBIA ASIA MEDAN
HS CARE PREMIER XTRA - O457 000065985462
JALU TEGAR PAMUNG RS. ST. ELISABETH - SEM
H&S INDIVIDU - H&S_IND O060 000039630537
ERWIN WIRAWAN RS. PANTAI INDAH KAPUK
HS CARE PREMIER XTRA - O473 000066125136
RISMA DAMAYANTI RS. EMC ALAM SUTERAHOSPITAL
(ID & SURGICAL CAO454 000054289745
VIVI ANITA WIDJAJA MAYAPADA HOSPITAL HS TANG CARE PREMIER XTRA - O672 000060982224
ALMA KIRANA AMARA BETHSAIDA HOSPITAL HOSPITAL
(IDR & SURGICAL CAO759 000054244309
AGUS SUSANTO SILOAM HOSPITALS BOGOR
H&S INDIVIDU - H&S_IND O357 000038065099
ELMER SAMUEL RS. MEDISTRA (IDR) - 07
HS CARE PREMIER XTRA - O731 000064857643
DJONI SILOAM HOSPITALS DHIRG
H&SR1 INDIVIDU - H&SR1_ O146 000055210734
BIMA PRATAMA SILOAM HOSPITALS SIMAT
HS CARE PREMIER XTRA - O449 000065872484
KHAYATIN NIKMAH RS. MITRA KELUARGA HOSPITAL
BEK & SURGICAL CAO549 000059407387
JOSEPH ALBERTUS RORS. GRHA KEDOYA (IDR) HOSPITAL & SURGICAL CAO655 000068098765
SHELFIN JUFIANDY MANDAYA ROYAL HOSPITAL HS CARE PREMIER XTRA - O462 000065946669
YOHANNA MORENA RS. GRHA KEDOYA (IDR) HOSPITAL & SURGICAL CAO641 000067888256
JOEL GOKLASMARTUASILOAM HOSPITALS KEBON HS CARE PREMIER XTRA - O440 000065775392
MUHAMMAD CAVERO W RS. PONDOK INDAH (IDR)
HS CARE PREMIER XTRA - O658 000063853402
PDT. SISWANTO AFANDNATIONAL HOSPITAL SURA
GKI SW JATIM GROUP - AL N166 GKISA-00004
DANIEL SATRIA MAHE RS. BAYUKARTA (IDR) H&SR1
-0 INDIVIDU - H&SR1_ O102 000050640446
YO FANNY HARIADI RS. PONDOK INDAH PURIH&SR1 I INDIVIDU - H&SR1_ O149 000051796041
MIKHA FELICIA EKA HOSPITAL PEKANBARU
HABCO PRIMATAMA, PT - AK279 HAPRI-00292
DYLAN KENZIE PARAMRS. BAPTIS KEDIRI (IDR)
GUDANG GARAM TBK. PT -F113 GUGAR-02606
TAUVAN KURNIAWAN RS. MITRA PLUMBON (IDR)HS CARE PREMIER XTRA - O652 000063810099
ADEEVA AFSHEEN MY RS. PRIMA HUSADA SUKORGUDANG GARAM TBK. PT -F113 GGSUR-00120
EINSLANA ANGELA KU MAYAPADA HOSPITAL HOSPITAL
KUNI & SURGICAL CAO594 000067239880
GUINANDRA NICKY AL RS. PERTAMEDIKA TARAKAN
HS CARE PREMIER XTRA - O590 000063171480
YOSY SETIANIE MANDAYA ROYAL HOSPITAL
HS CARE PREMIER XTRA - O472 000066102362
JUFIANA ARIFIN RS. MITRA KELUARGA HOSPITAL
KEL & SURGICAL CAO470 000065010963
ANITA SANTOSO RS. ST.CAROLUS (IDR) HOSPITAL
- & SURGICAL CAO763 000069743784
ROBERT MANSUR DAURS. ADVENT MEDAN (IDR) PT ALLIANZ LIFE INDONESIA
H438 ALZIN-00467
MEIKEL GOZALI RS. ROYAL TARUMA (IDR)
HS CARE PREMIER XTRA - O757 000069651130
RAYMOND RAMANAN MAYAPADA HOSPITAL HS JAKA
CARE PREMIER XTRA - O763 000060285217
CHINUA ORION PANGARS. YADIKA PONDOK BAMBU
H&SR1 INDIVIDU - H&SR1_ O119 000051494707
NUNING WARDHANI ADMRCCC-SILOAM HOSPITALSHS CARE PREMIER XTRA - O633 000067804185
YUSUF YUNIARTO RSPAD GATOT SUBROTO HS PA
CARE PREMIER XTRA - O682 000064243140
WIBOWO GUNAWAN RSPAD GATOT SUBROTO HOSPITAL
PA & SURGICAL CAO302 000044646191
SUGIARTI SILOAM HOSPITALS BOGOR
HOSPITAL & SURGICAL CAO622 000067579904
VINCENT KURNIAWANRS. PONDOK INDAH (IDR) HS CARE PREMIER XTRA - O488 000062400370
VIVIANA RS. MITRA KELUARGA HOSPITAL
BEK & SURGICAL CAO600 000067447913
AUDRIELLA RUTH JIM RS. EMC SENTUL (IDR)HOSPITAL
- & SURGICAL CAO579 000067208273
BENNY CORNELLIS GERS. ROYAL TARUMA (IDR)GUDANG GARAM TBK. PT -F113 GUGAR-03858
JOSEPH IMANUEL RS. ST.CAROLUS (IDR) HS
- CARE PREMIER XTRA - O589 000058532662
MEMBER ID
000062749480
000065491241
000069479779
000038810743
000068533963
EMIER XTRA-HSCPX_IND
000063603463
000058589670
000053602467
000061814534
000065034449
AGE-H&SO_IND
EMIER XTRA-HSCPX_IND
000040055123
000066734887
000069527908
000058953091
790300119200
000067503818
000061103828
EMIER XTRA-HSCPX_IND
EMIER XTRA-HSCPX_IND
SURGICAL CARE PREMIER PLUS-HSRP_IND
SURGICAL CARE PREMIER PLUS-HSRP_IND
SURGICAL CARE PREMIER PLUS-HSRP_IND
000057061763
000062631411
000056726397
000039740063
000062715345
000062308738
000058802861
000066124495
LEOCR-00000
000064098106
000065608285
000065505240
000069443102
000068706901
000066144163
000062599382
O686 000068447709
EMIER XTRA-HSCPX_IND
EMIER XTRA-HSCPX_IND
EMIER XTRA-HSCPX_IND
SURGICAL CARE PREMIER PLUS-HSRP_IND
SURGICAL CARE PREMIER PLUS-HSRP_IND
SURGICAL CARE PREMIER-HSAC_IND
SURGICAL CARE PREMIER PLUS-HSRP_IND
000065741414
000038903773
000068572052
000068332572
000068824640
000058444470
000063314350
000057671185
000069729212
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GUGAR-03600
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LPEIN-00100
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GKISA-00004
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HAPRI-00292
GUGAR-02606
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GGSUR-00120
000067239880
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O733 000064849507
O638 000051349806
O450 000062016042
O512 000062324873
O687 000067330816
O661 000068178106
O481 000057061795
O742 000069296019
O116 000059174939
O448 000061981602
O481 000062343034
O591 000040423165
O757 000069641756
O433 000070191870

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