Lampiran Desember

No No SEP Nama Peserta KodeRS No Peserta

1 0111R0021022V000578 SINTA LARAS SILVIA 0111R002 0000068906878

2 0111R0021022V000566 SRI MULYANI 0111R002 0001739275672
3 0111R0021022V000582 FEBRIYANTI SARI SETIARINI 0111R002 0001108060424
4 0111R0021022V000569 INA NURHAYATI 0111R002 0001728229116
5 0111R0021022V000510 NURLELAH 0111R002 0002770871769
6 0111R0021022V000256 ROHAYATI 0111R002 0002960088917
7 0111R0021022V000232 YANTI SUSANTI 0111R002 0000439200314
8 0111R0021022V000225 ELSA ROHMAYANTI 0111R002 0001515185684
9 0111R0021022V000218 VENNY MUTIA MULIADI 0111R002 0001840449317
10 0111R0021022V000231 HENI HANDAYANI 0111R002 0002794743641
11 0111R0021022V002806 RIANY KUSUMAWARDHANI 0111R002 0001410712492
12 0111R0021022V002735 WENI SILPIA 0111R002 0002486336444
13 0111R0021022V002800 WARNAH NURHASANAH 0111R002 0001476740507
14 0111R0021022V000148 ANIS ANDMAH 0111R002 0001014840955
15 0111R0021022V000137 MURYANTI 0111R002 0000509830468
16 0111R0021022V000152 BELIA 0111R002 0003003914079
17 0111R0021022V000134 NUR ALFIYAH 0111R002 0002588797787
18 0111R0021022V000153 NORIN NESA AULIA PUTRI 0111R002 0003286426937
19 0111R0021022V002596 LILIS SARTIKA 0111R002 0001812616277
20 0111R0021022V002569 MIMIN MINTARSIH 0111R002 0003174728815
21 0111R0021022V002415 WIDAYANTI 0111R002 0001107559664
22 0111R0021022V002312 RIRIN RAHMAYANI 0111R002 0000515617863
23 0111R0021022V002368 ANEU NOVIANI 0111R002 0001670701285
24 0111R0021022V002348 DIDA NURAPIDAH 0111R002 0001663930484
25 0111R0021022V002350 NETY HERAWATI 0111R002 0001529485953
26 0111R0021022V002328 ERNA WULANSARI 0111R002 0002509610253
27 0111R0021022V002185 ERIS MAYA RISMAYANTI 0111R002 0001107631765
28 0111R0021022V002220 ANIS INDIRA RESTIKA 0111R002 0002398444806
29 0111R0021022V002112 ROHAYATI 0111R002 0002960088917
30 0111R0021022V001893 DASA 0111R002 0002937620518
31 0111R0021022V001838 SELY DINA INDRIYANI 0111R002 0001800410141
32 0111R0021022V001803 DINI PRIANI 0111R002 0002356663713
33 0111R0021022V000049 IKO NURMALA ROSMINI 0111R002 0000516009879
34 0111R0021022V001687 GANDINI ANGGRAENI 0111R002 0001308135701
35 0111R0021022V001697 IRA APRILINA 0111R002 0001897237247
36 0111R0021022V001705 SITI ROHIMAH 0111R002 0000438590248
37 0111R0021022V001654 SRI ASRIANTI 0111R002 0002242647573
38 0111R0021022V001484 IRA RISMAYANTI 0111R002 0002286784001
39 0111R0021022V001571 PURWANINGSIH 0111R002 0001301182964
40 0111R0021022V001582 LASMINAH 0111R002 0002056194595
41 0111R0021022V001573 NURLELAH 0111R002 0002770871769
42 0111R0021022V001493 ENAH SUHAENAH 0111R002 0001668166738
43 0111R0021022V001400 ROHAYATI 0111R002 0002960088917
44 0111R0021022V001231 SITI MASITOH 0111R002 0001635287477
45 0111R0021022V001207 NENA NURAENI 0111R002 0003268882877
46 0111R0021022V001144 MAHESA UTAMI 0111R002 0000195674073
47 0111R0021022V001143 ENGKIM 0111R002 0001976333049
48 0111R0021022V001048 DEWI KANIAWATI 0111R002 0001902693069
49 0111R0021022V001021 DEWI SITI PATIMAH 0111R002 0001868882376
50 0111R0021022V001002 ANGGI EKA RESTIANI 0111R002 0002906864021
51 0111R0021022V000905 YAYU SOLIHAH  0111R002 0001005740537
52 0111R0021022V000856 DIDA NURAPIDAH 0111R002 0001663930484
53 0111R0021022V000919 LINA SITI KURNIASIH 0111R002 0002646171617
54 0111R0021022V000845 REVA SANDI 0111R002 0000516822805
55 0111R0021022V000762 SRI MUSRIAH 0111R002 0001664689206
56 0111R0021022V000719 AGUS ARISMA 0111R002 0000439332175
JUMLAH
 Sebelum Audit Klaim Setelah Audit Klaim
Kode Selisih
Diagnosa & Prosedur Biaya Diagnosa & Prosedur Kode Biaya
Ina CBGs
Ina CBGs
Z358;O996;O210;8878 Z-3-25-0 295,500 Z358;O996;O210;8878 Z-3-25-0 295,500 0
Z488;O342;O861 Q-5-44-0 185,000 Z392;O342;O861 Q-5-24-0 84,400 100,600
Z488;O342;9789 Q-5-44-0 185,000 Z392;O342;9789 Q-5-24-0 84,400 100,600
Z488;O342;9789 Q-5-44-0 185,000 Z392;O342;9789 Q-5-24-0 84,400 100,600
Z358;O470;O757;8878 Z-3-25-0 295,500 Z358;O470;O757;8878 Z-3-25-0 295,500 0
Z098;E119;N185;R104;9059Q-5-44-0 185,000 Z098;E119;N185;R104;905Q-5-44-0 185,000 0
Z358;O470;O998;8878 Z-3-25-0 295,500 Z358;O470;O998;8878 Z-3-25-0 295,500 0
Z488;O020 Q-5-44-0 185,000 Z488;O020 Q-5-44-0 185,000 0
Z488;O364 Q-5-44-0 185,000 Z488;O364 Q-5-44-0 185,000 0
Z358'O998;O120;8878 Z-3-25-0 295,500 Z358'O998;O120;8878 Z-3-25-0 295,500 0
Z488;O064 Q-5-44-0 185,000 Z488;O064 Q-5-44-0 185,000 0
Z488;O342 Q-5-44-0 185,000 Z392;O342 Q-5-24-0 84,400 100,600
Z098;K30 Q-5-44-0 185,000 Z719;K30 Q-5-18-0 127,800 57,200
Z358;O998;8878 Z-3-25-0 295,500 Z358;O998;8878 Z-3-25-0 295,500 0
Z358;O200;8878 Z-3-25-0 295,500 Z358;O200;8878 Z-3-25-0 295,500 0
Z488;O342 Q-5-44-0 185,000 Z392;O342 Q-5-24-0 84,400 100,600
Z358;O200;8878 Z-3-25-0 295,500 Z358;O200;8878 Z-3-25-0 295,500 0
Z488;O342;9789 Q-5-44-0 185,000 Z392;O342;9789 Q-5-24-0 84,400 100,600
Z488;O342;9059 Q-5-44-0 185,000 Z392;O342;9789 Q-5-24-0 84,400 100,600
Z488;O342 Q-5-44-0 185,000 Z392;O342 Q-5-24-0 84,400 100,600
Z358;O998;8878 Z-3-25-0 295,500 Z358;O998;8878 Z-3-25-0 295,500 0
Z488;O342 Q-5-44-0 185,000 Z392;O342 Q-5-24-0 84,400 100,600
Z488;N832 Q-5-44-0 185,000 Z488;N832 Q-5-44-0 185,000 0
Z488;O342 Q-5-44-0 185,000 Z392;O342 Q-5-24-0 84,400 100,600
Z488;O342 Q-5-44-0 185,000 Z392;O342 Q-5-24-0 84,400 100,600
Z358;O998;8878 Z-3-25-0 295,500 Z358;O998;8878 Z-3-25-0 295,500 0
Z488;O342 Q-5-44-0 185,000 Z392;O342 Q-5-24-0 84,400 100,600
Z488;O342 Q-5-44-0 185,000 Z392;O342 Q-5-24-0 84,400 100,600
Z098;E119;I10;N185 Q-5-44-0 185,000 Z098;E119;I10;N185 Q-5-44-0 185,000 0
Z098;N185;I10 Q-5-44-0 185,000 Z098;N185;I10 Q-5-44-0 185,000 0
Z488;O342 Q-5-44-0 185,000 Z392;O342 Q-5-24-0 84,400 100,600
Z488;O342 Q-5-44-0 185,000 Z392;O342 Q-5-24-0 84,400 100,600
K30 K-5-18-0 241,400 K30 K-5-18-0 241,400 0
Z488;O342 Q-5-44-0 185,000 Z392;O342 Q-5-24-0 84,400 100,600
Z488;O342 Q-5-44-0 185,000 Z392;O342 Q-5-24-0 84,400 100,600
Z488;O342 Q-5-44-0 185,000 Z392;O342 Q-5-24-0 84,400 100,600
Z488;O342 Q-5-44-0 185,000 Z392;O342 Q-5-24-0 84,400 100,600
Z358;O13;8878 Z-3-25-0 295,500 Z358;O13;8878 Z-3-25-0 295,500 0
Z488;O342 Q-5-44-0 185,000 Z392;O342 Q-5-24-0 84,400 100,600
Z488;N921 Q-5-44-0 185,000 Z488;N921 Q-5-44-0 185,000 0
Z488;O34.2 Q-5-44-0 185,000 Z392;O342 Q-5-24-0 84,400 100,600
Z358;O365;O996;8878 Z-3-25-0 295,500 Z358;O365;O996;8878 Z-3-25-0 295,500 0
Z098;E119;I119;N185;K30; Q-5-44-0 185,000 Z098;E119;I119;N185;K30 Q-5-44-0 185,000 0
Z358;O998;8878 Z-3-25-0 295,500 Z358;O998;8878 Z-3-25-0 295,500 0
Z488;O342 Q-5-44-0 185,000 Z392;O342 Q-5-24-0 84,400 100,600
Z358;O321;O998;8788 Z-3-25-0 295,500 Z358;O321;O998;8788 Z-3-25-0 295,500 0
Z098;N185 Q-5-44-0 185,000 Z098;N185 Q-5-44-0 185,000 0
Z488;O342 Q-5-44-0 185,000 Z392;O342 Q-5-24-0 84,400 100,600
Z488;O342 Q-5-44-0 185,000 Z392;O342 Q-5-24-0 84,400 100,600
Z488;O342 Q-5-44-0 185,000 Z392;O342 Q-5-24-0 84,400 100,600
Z488;O342 Q-5-44-0 185,000 Z392;O342 Q-5-24-0 84,400 100,600
Z358;O300;O321;8878 Z-3-25-0 295,500 Z358;O300;O321;8878 Z-3-25-0 295,500 0
Z488;O342 Q-5-44-0 185,000 Z392;O342 Q-5-24-0 84,400 100,600
Z488;O342 Q-5-44-0 185,000 Z392;O342 Q-5-24-0 84,400 100,600
Z098;N185;I10;9059 Q-5-44-0 185,000 Z098;N185;I10;9059 Q-5-44-0 185,000 0
Z098;K30 Q-5-44-0 185,000 Z098;K30 Q-5-44-0 185,000 0
11,963,400 9,089,400 2,874,000
 Keterangan

kontrol kehamilan dengan penyulit

sudah diperbaiki
sudah diperbaiki
sudah diperbaiki
kontrol kehamilan post ranap dengan penyulit
bukan rutin HD
sudah diperbaiki
post kuret
post kuret
kontrol kehamilan dengan penyulit
post kuret
sudah diperbaiki
konsultasi
kontrol kehamilan post rawat inap
kontrol kehamilan dgn ab
sudah diperbaiki
kontrol kehamilan dgn ab
sudah diperbaiki
sudah diperbaiki
sudah diperbaiki
kontrol kehamilan dengan penyulit
sudah diperbaiki
post bedah salpingektomy
sudah diperbaiki
sudah diperbaiki
kontrol kehamilan dengan penyulit
sudah diperbaiki
sudah diperbaiki
bukan rutin HD
tidak rutin HD
sudah diperbaiki
sudah diperbaiki
pasien IGD bukan kontrol poli
sudah diperbaiki
sudah diperbaiki
sudah diperbaiki
sudah diperbaiki
kontrol kehamilan dengan penyulit
sudah diperbaiki
post kuret
sudah diperbaiki
kontrol kehamilan dengan penyulit
tidak rutin HD
kontrol kehamilan post rawat inap
sudah diperbaiki
kontrol kehamilan dengan penyulit
tidak rutin HD, post rawat inap
sudah diperbaiki
sudah diperbaiki
sudah diperbaiki
sudah diperbaiki
kontrol kehamilan dengan penyulit
sudah diperbaiki
sudah diperbaiki
tidak rutin HD
kontrol post rawat inap