NOMOR JAMINAN NOFPK NOREGISTENOSURAT NOSURATSNOPENGAJTGLSEP TGLPULANLOS

1 JAMINAN C13081222C0187R006111167/BA/V
10523/BA/V
3507085IC2022-11-022022-11-021
2 JAMINAN C13081222C0187R006111167/BA/V
10523/BA/V
3507085IC2022-11-032022-11-031
3 JAMINAN C13081222C0187R006111167/BA/V
10523/BA/V
3507085IC2022-11-042022-11-041
4 JAMINAN C13081222C0187R006111167/BA/V
10523/BA/V
3507085IC2022-11-082022-11-081
5 JAMINAN C13081222C0187R006111167/BA/V
10523/BA/V
3507085IC2022-11-092022-11-091
6 JAMINAN C13081222C0187R006111167/BA/V
10523/BA/V
3507085IC2022-11-142022-11-141
7 JAMINAN C13081222C0187R006111167/BA/V
10523/BA/V
3507085IC2022-11-152022-11-151
8 JAMINAN C13081222C0187R006111167/BA/V
10523/BA/V
3507085IC2022-11-162022-11-161
9 JAMINAN C13081222C0187R006111167/BA/V
10523/BA/V
3507085IC2022-11-182022-11-181
10 JAMINAN C13081222C0187R006111167/BA/V
10523/BA/V
3507085IC2022-11-192022-11-191
11 JAMINAN C13081222C0187R006111167/BA/V
10523/BA/V
3507085IC2022-11-222022-11-221
12 JAMINAN C13081222C0187R006111167/BA/V
10523/BA/V
3507085IC2022-11-232022-11-231
13 JAMINAN C13081222C0187R006111167/BA/V
10523/BA/V
3507085IC2022-11-282022-11-281
14 JAMINAN C13081222C0187R006111167/BA/V
10523/BA/V
3507085IC2022-11-282022-11-281
15 JAMINAN C13081222C0187R006111167/BA/V
10523/BA/V
3507085IC2022-11-302022-11-301
JNSPEL NOIDENTITNMPESERTTGLLAHIRPUMUR KDINACBGTARIPINACTOTALGRUBYPENGAJ BYHASILVER
JALAN 351709***AR** FA******-**-186 Q-4-18-0 786000.00786000 786000.00786000.00
JALAN 350725***MU**********-**-070 Q-4-18-0 786000.00786000 786000.00786000.00
JALAN 351401***MI****** ****-**-1511 Q-4-18-0 786000.00786000 786000.00786000.00
JALAN 440/17***MU**********-**-140 Q-4-18-0 786000.00786000 786000.00786000.00
JALAN 350723***EN*** EF*****-**-2473 Q-4-18-0 786000.00786000 786000.00786000.00
JALAN 350920***TR** FE*******-**-0335 Q-4-18-0 786000.00786000 786000.00786000.00
JALAN 350725***SI** CH** ****-**-0231 Q-4-18-0 786000.00786000 786000.00786000.00
JALAN 350725***HI***** V ****-**-090 Q-4-18-0 786000.00786000 786000.00786000.00
JALAN 350725***WI**** ****-**-1365 Q-4-18-0 786000.00786000 786000.00786000.00
JALAN 350725***TU** ****-**-0182 Q-4-18-0 786000.00786000 786000.00786000.00
JALAN 350725***JU** HA******-**-1433 Q-4-18-0 786000.00786000 786000.00786000.00
JALAN 350725***SO***********-**-2369 Q-4-18-0 786000.00786000 786000.00786000.00
JALAN 351401***AC**** ****-**-0869 Q-4-18-0 786000.00786000 786000.00786000.00
JALAN 351401***DU***** ****-**-1149 Q-4-18-0 786000.00786000 786000.00786000.00
JALAN 351405***ED* SA*******-**-1120 Q-4-18-0 786000.00786000 786000.00786000.00
 KETERANGKRITERIA_DISPUTE
786000.00
786000.00
786000.00
786000.00
786000.00
786000.00
786000.00
786000.00
786000.00
786000.00
786000.00
786000.00
786000.00
786000.00
786000.00
NOMOR JAMINAN NOFPK NOREGISTENOSURAT NOSURATSNOPENGAJUAN TGLSEP
1 JAMINAN C13081222C0187R006111167/BA/V
10523/BA/V
3507085ICC2212000A 2022-11-03 19

2 JAMINAN C13081222C0187R006111167/BA/V
10523/BA/V
3507085ICC22120002 2022-11-24 07
TGLPULANLOS JNSPEL NOIDENTITNMPESERTTGLLAHIRPUMUR KDINACBGTARIPINACTOTALGRU
2022-11-031 JALAN 350725***SU****** ****-**-0965 Q-4-18-0 786000.00786000

2022-11-241 JALAN 350724***KR***** N****-**-0421 Q-4-18-0 786000.00786000

BYPENGAJ BYHASILVER
KETERANGAN KRITERIA_DISPUTE
786000.000.00 Double Klaim RJ, Pengajuan diagnosa Utama Suspek harus ada inputan
prosedur laboratorium darah rutin dan radiologi, surat keterangan PAPS
belum dilampirkan
, Pengajuan diagnosa Utama Suspek harus ada inputan prosedur
laboratorium darah rutin dan radiologi

786000.000.00 - mohon melampirkan hasil rapid ag maupun swab pcr pasien

, Double Klaim RJ, Pengajuan diagnosa Utama Suspek harus ada inputan
prosedur laboratorium darah rutin dan radiologi, Pengajuan diagnosa
Utama Suspek harus ada inputan prosedur laboratorium darah rutin dan
radiologi
KRITERIA_DISPUTE

Px tidak double klaim RJ. Untuk tgl 2-

11.2022 px dengan diagnosis berbeda dan
masuk klaim bpjs kesehatan. Inputan
prosedur lab darah rutin dan radiologi sudah
ada. Surat keterangan APS juga sudah ada.

Hasil Rapid Ag dilampirkan. Px tidak double

klaim RJ, tgl 22-11-2022 periksa dengan
diagnosis berbeda dan terklim BPJS
Kesehatan. Inputan lab darah rutin dan
radiologi sudah ada.