LAPORAN REKAP KLAIM - KLINIK UTAMA BUDI MULIA

Pasien Rawat Inap dan Rawat Jalan, Periode Tanggal Pulang: 1 Jul 2023 s/d 31 Jul 2023
Filter: / Kelas Rawat = Semua / Severity = Semua / Cara Pulang = Semua / Jenis Tarif = TARIF RS KELAS D SWASTA
No. Tgl. Masuk Tgl. Pulang No. RM Nama Pasien No. Klaim / SEP INACBG Top Up Total Tarif Tarif RS Jenis
1 1 Jul 2023 1 Jul 2023 9059/1120 SITI NURKHASANAH 0140S0020723V000001 Z-3-23-0 571.700 250.000 RJ
2 3 Jul 2023 3 Jul 2023 6825/0922 KAYSHILA KAHIYANG AYUNDA 0140S0020723V000016 Q-5-42-0 194.400 270.000 RJ
3 3 Jul 2023 3 Jul 2023 7979/0423 AHMAD HAFI BADALI 0140S0020723V000015 Q-5-44-0 197.600 270.000 RJ
4 3 Jul 2023 3 Jul 2023 6062/0723 MUHAMMAD FARHAN PRATAMA 0140S0020723V000014 Q-5-38-0 251.800 270.000 RJ
5 3 Jul 2023 3 Jul 2023 7996/0223 AISHWA MECCA ANZARI 0140S0020723V000013 Q-5-25-0 160.300 270.000 RJ
6 3 Jul 2023 3 Jul 2023 0578/0419 RISKAWATI, A.M KEB 0140S0020723V000012 Z-3-23-0 571.700 250.000 RJ
7 3 Jul 2023 3 Jul 2023 3314/0919 CYRA ZAINA PUTRI HARRA 0140S0020723V000011 J-3-13-0 330.500 270.000 RJ
8 3 Jul 2023 3 Jul 2023 10344/1121 EVA SAPUTRI SARMIYANTI 0140S0020723V000010 Z-3-25-0 319.800 250.000 RJ
9 3 Jul 2023 3 Jul 2023 1050/1017 PRADYPTA MAHENDRA PUTRA HARRA 0140S0020723V000009 Q-5-41-0 296.500 270.000 RJ
10 3 Jul 2023 3 Jul 2023 6059 AIDAN ATHALLAH RAHMAT 0140S0020723V000008 F-5-16-0 315.000 270.000 RJ
11 3 Jul 2023 3 Jul 2023 6616/0822 MUHAMMAD SYAWAL AKBAR 0140S0020723V000007 Q-5-42-0 194.400 270.000 RJ
12 3 Jul 2023 3 Jul 2023 15564/0723 ELAH JAMILAH 0140S0020723V000006 Z-3-23-0 571.700 250.000 RJ
13 3 Jul 2023 3 Jul 2023 6055/0723 MUHAMMAD RAFFASYA AL - FARIDZI 0140S0020723V000005 Q-5-42-0 194.400 270.000 RJ
14 3 Jul 2023 3 Jul 2023 01728/0218 ANSORI AZZARQY 0140S0020723V000004 J-3-13-0 330.500 270.000 RJ
15 4 Jul 2023 4 Jul 2023 15568/0723 NUR HIKMAH 0140S0020723V000036 Z-3-23-0 571.700 250.000 RJ
16 4 Jul 2023 4 Jul 2023 5593/0618 MAYANG SARI 0140S0020723V000035 Z-3-25-0 319.800 250.000 RJ
17 4 Jul 2023 4 Jul 2023 8019/1219 KHADIJAH 0140S0020723V000034 Z-3-25-0 319.800 250.000 RJ
18 4 Jul 2023 4 Jul 2023 6075/0723 MUHAMMAD ADAM 0140S0020723V000033 K-5-18-0 248.100 270.000 RJ
19 4 Jul 2023 4 Jul 2023 6041/0623 MIFTAKHUL JANNAH 0140S0020723V000032 Q-5-40-0 154.300 270.000 RJ
20 4 Jul 2023 4 Jul 2023 9801/0523 ZUBAIR ADNAN DAWUD 0140S0020723V000031 Q-5-42-0 194.400 270.000 RJ
21 4 Jul 2023 4 Jul 2023 6065/0723 SHIVA ANDRIYANA 0140S0020723V000030 Q-5-43-0 271.400 270.000 RJ
22 4 Jul 2023 4 Jul 2023 0907/0717 ANNASYA NUR RAYSA 0140S0020723V000029 J-3-13-0 330.500 270.000 RJ
23 4 Jul 2023 4 Jul 2023 5954/0623 MEYDIAN NANDA RIO SAPUTRA 0140S0020723V000028 Q-5-33-0 184.600 270.000 RJ
24 4 Jul 2023 4 Jul 2023 5381/1021 LAILLATUL RAMADHAN 0140S0020723V000027 Q-5-44-0 197.600 270.000 RJ
25 4 Jul 2023 4 Jul 2023 1235/1221 ALIJA NUR GHANIYAH 0140S0020723V000026 J-3-13-0 330.500 270.000 RJ
26 4 Jul 2023 4 Jul 2023 6070/0723 AQUEENA RHIZIYA BOERNEO 0140S0020723V000025 Q-5-44-0 197.600 270.000 RJ
27 4 Jul 2023 4 Jul 2023 6071/0723 MUHAMMAD ALFIN GHANI 0140S0020723V000024 Q-5-44-0 197.600 270.000 RJ
28 4 Jul 2023 4 Jul 2023 4282/0720 AYRA SHIRLY ZEEVANA 0140S0020723V000023 J-3-13-0 330.500 270.000 RJ
29 4 Jul 2023 4 Jul 2023 9700/0423 ALIKA KAILA PUTRI 0140S0020723V000020 Q-5-44-0 197.600 270.000 RJ
30 5 Jul 2023 5 Jul 2023 15575/0723 CARENINA DWI KARTIKA SARI 0140S0020723V000048 Z-3-23-0 571.700 250.000 RJ
31 5 Jul 2023 5 Jul 2023 7116/0419 IKA WIRAYANTI 0140S0020723V000047 Z-3-25-0 319.800 250.000 RJ
32 5 Jul 2023 5 Jul 2023 15554/0623 KURNIA SARI 0140S0020723V000046 Q-5-44-0 197.600 250.000 RJ
33 5 Jul 2023 5 Jul 2023 0578/0419 RISKAWATI, A.M KEB 0140S0020723V000045 Q-5-44-0 197.600 250.000 RJ
34 5 Jul 2023 5 Jul 2023 15305/0423 WENI SUSANTI 0140S0020723V000044 Z-3-23-0 571.700 250.000 RJ

Kode RS: K6401002 Halaman 1/6

 LAPORAN REKAP KLAIM - KLINIK UTAMA BUDI MULIA
Pasien Rawat Inap dan Rawat Jalan, Periode Tanggal Pulang: 1 Jul 2023 s/d 31 Jul 2023
Filter: / Kelas Rawat = Semua / Severity = Semua / Cara Pulang = Semua / Jenis Tarif = TARIF RS KELAS D SWASTA
No. Tgl. Masuk Tgl. Pulang No. RM Nama Pasien No. Klaim / SEP INACBG Top Up Total Tarif Tarif RS Jenis
35 5 Jul 2023 5 Jul 2023 15573/0123 INUN 0140S0020723V000043 Z-3-23-0 571.700 250.000 RJ
36 5 Jul 2023 5 Jul 2023 7836/0223 MUHAMMAD RIFKI FADILAH 0140S0020723V000042 Q-5-43-0 271.400 270.000 RJ
37 5 Jul 2023 5 Jul 2023 6795/0822 GIBRAN ABU CHALIS 0140S0020723V000041 Q-5-42-0 194.400 270.000 RJ
38 5 Jul 2023 5 Jul 2023 2592/0219 GIBRAN ALVARO 0140S0020723V000040 Q-5-43-0 271.400 270.000 RJ
39 6 Jul 2023 6 Jul 2023 7123/1022 MUHAMMAD FIKRI 0140S0020723V000057 J-3-13-0 330.500 270.000 RJ
40 6 Jul 2023 6 Jul 2023 3965/0220 M. IBNU SINA PRATAMA 0140S0020723V000056 Q-5-25-0 160.300 270.000 RJ
41 6 Jul 2023 6 Jul 2023 6034/0623 MUHAMMAD RAFLI 0140S0020723V000055 Q-5-44-0 197.600 270.000 RJ
42 6 Jul 2023 6 Jul 2023 6081/0723 AHMAD HAFIZHUL AZAM 0140S0020723V000054 J-3-13-0 330.500 270.000 RJ
43 6 Jul 2023 6 Jul 2023 1214/1117 FARRAS MUHAMMAD RIZKY 0140S0020723V000053 F-5-16-0 315.000 270.000 RJ
44 7 Jul 2023 7 Jul 2023 6086/0723 AARA ZAHIRAH IBRAHIM 0140S0020723V000065 J-3-13-0 330.500 270.000 RJ
45 7 Jul 2023 7 Jul 2023 0939/0817 NAFISHA YUMNAA AZKADINA 0140S0020723V000064 Q-5-44-0 197.600 270.000 RJ
46 7 Jul 2023 7 Jul 2023 7785/0123 MUHAMMAD IRZANNUR AZUSA AZMI 0140S0020723V000063 J-3-13-0 330.500 270.000 RJ
47 7 Jul 2023 7 Jul 2023 1046/1017 MUHAMMAD AL KHALIFI HAFIDZUAN 0140S0020723V000062 J-3-13-0 330.500 270.000 RJ
48 7 Jul 2023 7 Jul 2023 7987/1219 YUSIDAR 0140S0020723V000061 Z-3-23-0 571.700 250.000 RJ
49 7 Jul 2023 7 Jul 2023 15578/0723 SITI YULIYANTI NINGSIH 0140S0020723V000060 Z-3-25-0 319.800 250.000 RJ
50 8 Jul 2023 8 Jul 2023 6612/0119 NORLIANA 0140S0020723V000077 Z-3-25-0 319.800 250.000 RJ
51 8 Jul 2023 8 Jul 2023 4848/0318 OKTAFIOLA SUPRAYOGI 0140S0020723V000076 Z-3-23-0 571.700 250.000 RJ
52 8 Jul 2023 8 Jul 2023 6093/0723 IMAROH IZTHIHAR NUR MAHDIN 0140S0020723V000075 Q-5-44-0 197.600 270.000 RJ
53 8 Jul 2023 8 Jul 2023 2098/0918 QIANA YUNA ALMAHYRA 0140S0020723V000074 J-3-13-0 330.500 270.000 RJ
54 8 Jul 2023 8 Jul 2023 3281/0819 FATHIAN SAIF EZHAR 0140S0020723V000073 F-5-16-0 315.000 270.000 RJ
55 8 Jul 2023 8 Jul 2023 7837/0223 HANA ILYANA IKHSAN 0140S0020723V000072 K-5-18-0 248.100 270.000 RJ
56 8 Jul 2023 8 Jul 2023 06098/0723 NAFIA WAFIATUL ULA SETIAWAN 0140S0020723V000071 J-3-13-0 330.500 270.000 RJ
57 8 Jul 2023 8 Jul 2023 6016/0623 NAURA AURELIA QIANZI 0140S0020723V000070 J-3-13-0 330.500 270.000 RJ
58 8 Jul 2023 8 Jul 2023 9801/0523 ZUBAIR ADNAN DAWUD 0140S0020723V000069 Q-5-44-0 197.600 270.000 RJ
59 8 Jul 2023 8 Jul 2023 15538/0623 RESSA 0140S0020723V000068 Z-3-25-0 319.800 250.000 RJ
60 8 Jul 2023 8 Jul 2023 7839/0123 MUHAMMAD YUSUF ATHALLAH 0140S0020723V000066 F-5-16-0 315.000 270.000 RJ
61 10 Jul 2023 10 Jul 2023 15593/0723 NURSIYATI 0140S0020723V000086 Z-3-25-0 319.800 250.000 RJ
62 10 Jul 2023 10 Jul 2023 15592/0723 DEWI AGUSTINA 0140S0020723V000085 Z-3-25-0 319.800 250.000 RJ
63 10 Jul 2023 10 Jul 2023 6071/0723 MUHAMMAD ALFIN GHANI 0140S0020723V000084 Q-5-38-0 251.800 270.000 RJ
64 10 Jul 2023 10 Jul 2023 5597/1221 SEAN GEOVANI SEMBIRING 0140S0020723V000083 Q-5-42-0 194.400 270.000 RJ
65 10 Jul 2023 10 Jul 2023 6098/0723 HABIBAH WAFA ASSYIFFA 0140S0020723V000082 Q-5-44-0 197.600 270.000 RJ
66 10 Jul 2023 10 Jul 2023 7617/1122 NUR ALMIRA RAISSA 0140S0020723V000081 Q-5-42-0 194.400 270.000 RJ
67 10 Jul 2023 10 Jul 2023 6095/0723 MUHAMMAD BAYU 0140S0020723V000080 Q-5-44-0 197.600 270.000 RJ
68 10 Jul 2023 10 Jul 2023 6202/0422 FATTAR RIO RAJABAIN 0140S0020723V000079 J-3-13-0 330.500 270.000 RJ

Kode RS: K6401002 Halaman 2/6

 LAPORAN REKAP KLAIM - KLINIK UTAMA BUDI MULIA
Pasien Rawat Inap dan Rawat Jalan, Periode Tanggal Pulang: 1 Jul 2023 s/d 31 Jul 2023
Filter: / Kelas Rawat = Semua / Severity = Semua / Cara Pulang = Semua / Jenis Tarif = TARIF RS KELAS D SWASTA
No. Tgl. Masuk Tgl. Pulang No. RM Nama Pasien No. Klaim / SEP INACBG Top Up Total Tarif Tarif RS Jenis
69 11 Jul 2023 11 Jul 2023 15568/0723 NUR HIKMAH 0140S0020723V000092 Q-5-44-0 197.600 250.000 RJ
70 11 Jul 2023 11 Jul 2023 11858/1223 ESYAH 0140S0020723V000091 Z-3-25-0 319.800 250.000 RJ
71 11 Jul 2023 11 Jul 2023 15225/0323 RENI DWI PRAMITA 0140S0020723V000090 Z-3-25-0 319.800 250.000 RJ
72 11 Jul 2023 11 Jul 2023 4958/0621 MUHAMMAD AL FATIH 0140S0020723V000089 J-3-13-0 330.500 270.000 RJ
73 12 Jul 2023 12 Jul 2023 15603/0723 DEWI RACHAYU .A 0140S0020723V000103 Z-3-25-0 319.800 250.000 RJ
74 12 Jul 2023 12 Jul 2023 3226/0819 EZRA ACHAZIA ARRAZY 0140S0020723V000102 F-5-16-0 315.000 270.000 RJ
75 12 Jul 2023 12 Jul 2023 1701/0118 AHMAD ARIF 0140S0020723V000101 J-3-13-0 330.500 270.000 RJ
76 12 Jul 2023 12 Jul 2023 2687/0319 RAFFASYA RAFKA JURAEJE 0140S0020723V000100 J-3-13-0 330.500 270.000 RJ
77 12 Jul 2023 12 Jul 2023 2892/0519 HALWA QANITA 0140S0020723V000099 F-5-16-0 315.000 270.000 RJ
78 12 Jul 2023 12 Jul 2023 0907/0717 ANNASYA NUR RAYSA 0140S0020723V000098 Q-5-44-0 197.600 270.000 RJ
79 12 Jul 2023 12 Jul 2023 4579/0121 ELVANO ARKANA KENZIE ARITONANG 0140S0020723V000096 Q-5-42-0 194.400 270.000 RJ
80 12 Jul 2023 12 Jul 2023 6120/0723 BAYI NYONYA RISKA DAHLIA OKTAFIANI 0140S0020723V000094 P-9-17-0 301.300 270.000 RJ
81 13 Jul 2023 13 Jul 2023 05781/0623 BAYI NYONYA RISKY ANANDA MAULANI 0140S0020723V000106 P-9-17-0 301.300 520.000 RJ
82 13 Jul 2023 13 Jul 2023 3965/0220 M. IBNU SINA PRATAMA 0140S0020723V000110 Q-5-38-0 251.800 270.000 RJ
83 13 Jul 2023 13 Jul 2023 61012/0723 BALQIS MYSHA 0140S0020723V000109 F-5-16-0 315.000 270.000 RJ
84 13 Jul 2023 13 Jul 2023 2090/0122 MUHAMAD ABDURRAHMAN 0140S0020723V000108 Q-5-44-0 197.600 270.000 RJ
85 13 Jul 2023 13 Jul 2023 61013/0723 NABIH AUFAR 0140S0020723V000107 J-3-13-0 330.500 270.000 RJ
86 15 Jul 2023 15 Jul 2023 1509/0423 HURNIAWATI 0140S0020723V000115 Z-3-25-0 319.800 250.000 RJ
87 17 Jul 2023 17 Jul 2023 4498/1220 SITTI NUR JANNAH SALSABILA 0140S0020723V000138 Q-5-42-0 194.400 270.000 RJ
88 17 Jul 2023 17 Jul 2023 7888/0723 VALEZKA QUEENZEE HERLIANSYAH 0140S0020723V000137 J-3-13-0 330.500 270.000 RJ
89 17 Jul 2023 17 Jul 2023 7758/1021 MUHAMMAD RIAN 0140S0020723V000136 J-3-13-0 330.500 270.000 RJ
90 17 Jul 2023 17 Jul 2023 7889/0323 PUTRI MUTIAH 0140S0020723V000135 Q-5-44-0 197.600 270.000 RJ
91 17 Jul 2023 17 Jul 2023 7837/0223 HANA ILYANA IKHSAN 0140S0020723V000134 J-3-13-0 330.500 270.000 RJ
92 17 Jul 2023 17 Jul 2023 6095/0723 MUHAMMAD BAYU 0140S0020723V000133 Q-5-44-0 197.600 270.000 RJ
93 17 Jul 2023 17 Jul 2023 5751/0122 MUHAMMAD AGRATA FARABI 0140S0020723V000132 J-3-13-0 330.500 270.000 RJ
RAHMATULLAH
94 17 Jul 2023 17 Jul 2023 4561/0223 ATHIYAH RANA SHAFIYYAH 0140S0020723V000131 J-3-13-0 330.500 270.000 RJ
95 17 Jul 2023 17 Jul 2023 7888/0123 MUHAMMAD YUSUF FARZANI 0140S0020723V000130 J-3-13-0 330.500 270.000 RJ
96 17 Jul 2023 17 Jul 2023 7894/0323 MUHAMMAD ARKANA AL GHIFARI 0140S0020723V000129 J-3-13-0 330.500 270.000 RJ
97 17 Jul 2023 17 Jul 2023 7941/0323 MUHAMMAD RAHSYAN NAUFALRIZQI 0140S0020723V000128 Q-5-42-0 194.400 270.000 RJ
ANNOOR
98 17 Jul 2023 17 Jul 2023 6061/0723 FAWAZ ALSYAHFIQ RAMADHAN 0140S0020723V000127 J-3-13-0 330.500 270.000 RJ
99 17 Jul 2023 17 Jul 2023 4352/0521 TRI RUSMAWATI 0140S0020723V000126 Z-3-23-0 571.700 250.000 RJ
100 17 Jul 2023 17 Jul 2023 61019/0723 MUHAMMAD RAIZEN AIR FAWWAZ 0140S0020723V000125 J-3-13-0 330.500 270.000 RJ
PRATAMA
Kode RS: K6401002 Halaman 3/6
 LAPORAN REKAP KLAIM - KLINIK UTAMA BUDI MULIA
Pasien Rawat Inap dan Rawat Jalan, Periode Tanggal Pulang: 1 Jul 2023 s/d 31 Jul 2023
Filter: / Kelas Rawat = Semua / Severity = Semua / Cara Pulang = Semua / Jenis Tarif = TARIF RS KELAS D SWASTA
No. Tgl. Masuk Tgl. Pulang No. RM Nama Pasien No. Klaim / SEP INACBG Top Up Total Tarif Tarif RS Jenis
101 17 Jul 2023 17 Jul 2023 61021/0723 ZIKROQIB SYAKHIR 0140S0020723V000124 J-3-13-0 330.500 270.000 RJ
102 17 Jul 2023 17 Jul 2023 3399/0919 MUHAMMAD MALIK BAIHAQIE 0140S0020723V000123 J-3-13-0 330.500 270.000 RJ
103 17 Jul 2023 17 Jul 2023 15498/0623 MARTIANA 0140S0020723V000122 Z-3-25-0 319.800 250.000 RJ
104 17 Jul 2023 17 Jul 2023 7895/0223 BAYI NYONYA LINA ZAHRATUL NISA' I 0140S0020723V000121 J-3-13-0 330.500 270.000 RJ
105 17 Jul 2023 17 Jul 2023 3690/1219 DZAKIRA AINUSYAMS CHANDRA 0140S0020723V000120 J-3-13-0 330.500 270.000 RJ
106 17 Jul 2023 17 Jul 2023 0581/1216 LEMYA EBTISAMAH CHANDRA 0140S0020723V000119 Q-5-44-0 197.600 270.000 RJ
107 18 Jul 2023 18 Jul 2023 7977/1019 NUR ALDIA FETIANASARI 0140S0020723V000151 Z-3-25-0 319.800 250.000 RJ
108 18 Jul 2023 18 Jul 2023 5403/0518 MUSTIYAH 0140S0020723V000150 Q-5-44-0 197.600 250.000 RJ
109 18 Jul 2023 18 Jul 2023 7019/0419 SITI NUR KHADIJAH 0140S0020723V000149 Z-3-23-0 571.700 250.000 RJ
110 18 Jul 2023 18 Jul 2023 15617/0723 KASMAH 0140S0020723V000148 Z-3-23-0 571.700 250.000 RJ
111 18 Jul 2023 18 Jul 2023 6819/0219 NURHIKMAH 0140S0020723V000147 Z-3-25-0 319.800 250.000 RJ
112 18 Jul 2023 18 Jul 2023 11162/0522 NOPYTHA NORMAULY SIMANULLANG 0140S0020723V000146 Z-3-25-0 319.800 250.000 RJ
113 18 Jul 2023 18 Jul 2023 9806/0523 MUHAMMAD ALTHAF ZAYAN AHMADI 0140S0020723V000145 Q-5-42-0 194.400 270.000 RJ
114 18 Jul 2023 18 Jul 2023 1864/0618 MUHAMMAD RIZKI NUR AZMI 0140S0020723V000144 F-5-16-0 315.000 270.000 RJ
115 18 Jul 2023 18 Jul 2023 7785/0123 MUHAMMAD IRZANNUR AZUSA AZMI 0140S0020723V000143 J-3-13-0 330.500 270.000 RJ
116 20 Jul 2023 20 Jul 2023 6831/0523 PUTRI DEWI NAWANG WULAN 0140S0020723V000159 J-3-13-0 330.500 270.000 RJ
117 20 Jul 2023 20 Jul 2023 6048/0623 SABRINA OKTAVIA 0140S0020723V000158 J-3-13-0 330.500 270.000 RJ
118 20 Jul 2023 20 Jul 2023 0223 MUHAMMAD HISYAM ABDURRAHMAN 0140S0020723V000157 Q-5-42-0 194.400 270.000 RJ
AZZUHAIRI
119 20 Jul 2023 20 Jul 2023 6614/0822 MUHAMMAD IKHWAN HADI 0140S0020723V000156 Q-5-44-0 197.600 270.000 RJ
120 20 Jul 2023 20 Jul 2023 7864/0223 MUHHAMMAD DEANDRA KAIVAN KAYANA 0140S0020723V000155 J-3-13-0 330.500 270.000 RJ
121 20 Jul 2023 20 Jul 2023 9708/0423 DION TEGAR PRATAMA 0140S0020723V000154 F-5-16-0 315.000 270.000 RJ
122 21 Jul 2023 21 Jul 2023 0416/0616 PUTRA ADITYA 0140S0020723V000161 Q-5-41-0 296.500 270.000 RJ
123 24 Jul 2023 24 Jul 2023 1770/0518 HABIBI ABDUL MUBAROK 0140S0020723V000182 J-3-13-0 330.500 270.000 RJ
124 24 Jul 2023 24 Jul 2023 6824/0922 HILYA ABDILLAH ZARA 0140S0020723V000181 J-3-13-0 330.500 270.000 RJ
125 24 Jul 2023 24 Jul 2023 4087/0320 MUHAMMAD FADIL ASHABY 0140S0020723V000180 J-3-13-0 330.500 270.000 RJ
126 24 Jul 2023 24 Jul 2023 6689/0822 MUHAMMAD NIZAR ALFARIZI 0140S0020723V000179 Q-5-44-0 197.600 270.000 RJ
127 24 Jul 2023 24 Jul 2023 7277/1022 MUHAMMAD RAYHAN AL FAEZA 0140S0020723V000178 Q-5-44-0 197.600 270.000 RJ
128 24 Jul 2023 24 Jul 2023 15633/0723 SITI HAJARIYAH 0140S0020723V000177 Z-3-23-0 571.700 250.000 RJ
129 24 Jul 2023 24 Jul 2023 5328/1021 KHALIFA 0140S0020723V000176 J-3-13-0 330.500 270.000 RJ
130 24 Jul 2023 24 Jul 2023 7800/0223 ZUKHRUFAH NUR NABILAH 0140S0020723V000175 J-3-13-0 330.500 270.000 RJ
131 24 Jul 2023 24 Jul 2023 3690/1219 DZAKIRA AINUSYAMS CHANDRA 0140S0020723V000174 J-3-13-0 330.500 270.000 RJ
132 24 Jul 2023 24 Jul 2023 0581/1216 LEMYA EBTISAMAH CHANDRA 0140S0020723V000173 J-3-13-0 330.500 270.000 RJ
133 24 Jul 2023 24 Jul 2023 7895/0223 BAYI NYONYA LINA ZAHRATUL NISA' I 0140S0020723V000172 J-3-13-0 330.500 270.000 RJ

Kode RS: K6401002 Halaman 4/6

 LAPORAN REKAP KLAIM - KLINIK UTAMA BUDI MULIA
Pasien Rawat Inap dan Rawat Jalan, Periode Tanggal Pulang: 1 Jul 2023 s/d 31 Jul 2023
Filter: / Kelas Rawat = Semua / Severity = Semua / Cara Pulang = Semua / Jenis Tarif = TARIF RS KELAS D SWASTA
No. Tgl. Masuk Tgl. Pulang No. RM Nama Pasien No. Klaim / SEP INACBG Top Up Total Tarif Tarif RS Jenis
134 24 Jul 2023 24 Jul 2023 6795/0822 GIBRAN ABU CHALIS 0140S0020723V000171 J-3-13-0 330.500 270.000 RJ
135 24 Jul 2023 24 Jul 2023 5597/1221 SEAN GEOVANI SEMBIRING 0140S0020723V000170 J-3-13-0 330.500 270.000 RJ
136 24 Jul 2023 24 Jul 2023 7276/1022 AFIZA GHANIA 0140S0020723V000169 Q-5-42-0 194.400 270.000 RJ
137 24 Jul 2023 24 Jul 2023 6888/0922 ATHA KHALID NAZRIEL 0140S0020723V000168 J-3-13-0 330.500 270.000 RJ
138 24 Jul 2023 24 Jul 2023 1686/0118 ATHAYA HAZIQ FATHAN 0140S0020723V000167 Q-5-44-0 197.600 270.000 RJ
139 24 Jul 2023 24 Jul 2023 0081/0917 ATHIYAH HASNA KHALISHA 0140S0020723V000166 J-3-13-0 330.500 270.000 RJ
140 24 Jul 2023 24 Jul 2023 3399/0919 MUHAMMAD MALIK BAIHAQIE 0140S0020723V000165 J-3-13-0 330.500 270.000 RJ
141 24 Jul 2023 24 Jul 2023 7093/1022 MUHAMMAD NUR YUSUF AL QADRI 0140S0020723V000164 J-3-13-0 330.500 270.000 RJ
142 24 Jul 2023 24 Jul 2023 6831/0523 PUTRI DEWI NAWANG WULAN 0140S0020723V000163 J-3-13-0 330.500 270.000 RJ
143 25 Jul 2023 25 Jul 2023 5095/0721 MUHAMMAD MAULANA 0140S0020723V000191 Q-5-44-0 197.600 270.000 RJ
144 25 Jul 2023 25 Jul 2023 9728/0423 MUHAMAD SAID AHAWAL 0140S0020723V000190 Q-5-34-0 224.700 270.000 RJ
145 25 Jul 2023 25 Jul 2023 7894/0323 MUHAMMAD ARKANA AL GHIFARI 0140S0020723V000189 J-3-13-0 330.500 270.000 RJ
146 25 Jul 2023 25 Jul 2023 6391/0622 BAYI NYONYA SRI DEVI 0140S0020723V000188 J-3-13-0 330.500 270.000 RJ
147 25 Jul 2023 25 Jul 2023 6181/0422 FABIAN ADE FIRMANSYAH 0140S0020723V000187 J-3-13-0 330.500 270.000 RJ
148 25 Jul 2023 25 Jul 2023 7992/0423 BASO HAIKAL PRATAMA 0140S0020723V000186 Q-5-42-0 194.400 270.000 RJ
149 25 Jul 2023 25 Jul 2023 9801/0523 ZUBAIR ADNAN DAWUD 0140S0020723V000185 Q-5-44-0 197.600 270.000 RJ
150 26 Jul 2023 26 Jul 2023 15743/0723 RINA SUGIARTI 0140S0020723V000196 Z-3-25-0 319.800 250.000 RJ
151 26 Jul 2023 26 Jul 2023 4958/0621 MUHAMMAD AL FATIH 0140S0020723V000195 J-3-13-0 330.500 270.000 RJ
152 26 Jul 2023 26 Jul 2023 6024/0222 ALFATIH KENZIE HAZIQ SOFYAN 0140S0020723V000194 J-3-13-0 330.500 270.000 RJ
153 26 Jul 2023 26 Jul 2023 7016/1022 MUHAMMAD ERHAN ARKANA 0140S0020723V000193 J-3-13-0 330.500 270.000 RJ
154 27 Jul 2023 27 Jul 2023 15741/0723 HEMIYANTI 0140S0020723V000200 Z-3-23-0 571.700 250.000 RJ
155 28 Jul 2023 28 Jul 2023 9205/1220 DAHNIA 0140S0020723V000206 Z-3-23-0 571.700 250.000 RJ
156 28 Jul 2023 28 Jul 2023 15026/0323 DIAH PUJIPRASTUTI 0140S0020723V000205 Z-3-23-0 571.700 250.000 RJ
157 28 Jul 2023 28 Jul 2023 11203/0522 SUSILAWATI 0140S0020723V000204 Z-3-23-0 571.700 250.000 RJ
158 28 Jul 2023 28 Jul 2023 15746/0523 LUTURMAS,ERIKA STEPHANIE 0140S0020723V000203 Z-3-23-0 571.700 250.000 RJ
159 28 Jul 2023 28 Jul 2023 7989/0123 MUHAMMAD ALFATIH 0140S0020723V000202 F-5-16-0 315.000 270.000 RJ
160 29 Jul 2023 29 Jul 2023 15755/0723 KASMAWATI 0140S0020723V000215 Z-3-25-0 319.800 250.000 RJ
161 29 Jul 2023 29 Jul 2023 5300/0921 MUHAMMAD AZKA ALKHALIFI 0140S0020723V000214 Q-5-42-0 194.400 270.000 RJ
162 29 Jul 2023 29 Jul 2023 5416/1021 AHMAD NIZAM AFFANDI KURNIAWAN 0140S0020723V000213 F-5-16-0 315.000 270.000 RJ
163 29 Jul 2023 29 Jul 2023 7294/1022 AHMAD RAYYANZA ALFARIZQI 0140S0020723V000212 J-3-13-0 330.500 270.000 RJ
164 29 Jul 2023 29 Jul 2023 7843/0123 NOR FARIZ AZMI 0140S0020723V000211 F-5-16-0 315.000 270.000 RJ
165 29 Jul 2023 29 Jul 2023 61019/0723 MUHAMMAD RAIZEN AIR FAWWAZ 0140S0020723V000210 J-3-13-0 330.500 270.000 RJ
PRATAMA
166 29 Jul 2023 29 Jul 2023 61058/0723 MUHAMMAD RAZKA PRATAMA 0140S0020723V000209 Q-5-42-0 194.400 270.000 RJ

Kode RS: K6401002 Halaman 5/6

 LAPORAN REKAP KLAIM - KLINIK UTAMA BUDI MULIA
Pasien Rawat Inap dan Rawat Jalan, Periode Tanggal Pulang: 1 Jul 2023 s/d 31 Jul 2023
Filter: / Kelas Rawat = Semua / Severity = Semua / Cara Pulang = Semua / Jenis Tarif = TARIF RS KELAS D SWASTA
No. Tgl. Masuk Tgl. Pulang No. RM Nama Pasien No. Klaim / SEP INACBG Top Up Total Tarif Tarif RS Jenis
167 29 Jul 2023 29 Jul 2023 6831/0523 PUTRI DEWI NAWANG WULAN 0140S0020723V000208 J-3-13-0 330.500 270.000 RJ
168 31 Jul 2023 31 Jul 2023 15759/0723 MARSYA KHADIVA AZ-SAHRA 0140S0020723V000230 Z-3-23-0 571.700 250.000 RJ
169 31 Jul 2023 31 Jul 2023 4352/0521 TRI RUSMAWATI 0140S0020723V000229 Q-5-40-0 154.300 250.000 RJ
170 31 Jul 2023 31 Jul 2023 15761/0723 MONIKHA ADE LUSIANA 0140S0020723V000228 Z-3-25-0 319.800 250.000 RJ
171 31 Jul 2023 31 Jul 2023 61065/0723 GUSTI AZKAYRA QIANA SHEZAN 0140S0020723V000227 J-3-13-0 330.500 270.000 RJ
172 31 Jul 2023 31 Jul 2023 4561/0223 ATHIYAH RANA SHAFIYYAH 0140S0020723V000226 J-3-13-0 330.500 270.000 RJ
173 31 Jul 2023 31 Jul 2023 0581/1216 LEMYA EBTISAMAH CHANDRA 0140S0020723V000225 J-3-13-0 330.500 270.000 RJ
174 31 Jul 2023 31 Jul 2023 79559/0123 MUHAMMAD AHSAN KAMIL 0140S0020723V000224 J-3-13-0 330.500 270.000 RJ
175 31 Jul 2023 31 Jul 2023 7888/0723 VALEZKA QUEENZEE HERLIANSYAH 0140S0020723V000223 J-3-13-0 330.500 270.000 RJ
176 31 Jul 2023 31 Jul 2023 61060/0723 AHMAD SYAHRAZAD 0140S0020723V000222 Q-5-42-0 194.400 270.000 RJ
177 31 Jul 2023 31 Jul 2023 4560/0221 ALESHA CLEMIRA PRADANA 0140S0020723V000221 Q-5-44-0 197.600 270.000 RJ
178 31 Jul 2023 31 Jul 2023 6689/0822 MUHAMMAD NIZAR ALFARIZI 0140S0020723V000220 J-3-13-0 330.500 270.000 RJ
179 31 Jul 2023 31 Jul 2023 2094/0918 MUHAMMAD NAZRIL MAULANA SYUKUR 0140S0020723V000219 J-3-13-0 330.500 270.000 RJ
180 31 Jul 2023 31 Jul 2023 3399/0919 MUHAMMAD MALIK BAIHAQIE 0140S0020723V000218 J-3-13-0 330.500 270.000 RJ
181 31 Jul 2023 31 Jul 2023 61062/0723 MOHAMMAD AYI DIPO WICAKSONO 0140S0020723V000217 Q-5-44-0 197.600 270.000 RJ
Total 56.319.300 48.240.000

Kode RS: K6401002 Halaman 6/6