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    The document summarizes the claim verification results from BPJS Kesehatan for provider YUNITA PUSPASARI for August 2023. It shows that the total submitted claims were 23, totaling Rp 18.4 million. All 23 claims were verified as eligible with no pending or disputed claims. The verification results were approved by the FKTP on September 18, 2023.

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    The document summarizes the claim verification results from BPJS Kesehatan for provider YUNITA PUSPASARI for August 2023. It shows that the total submitted claims were 23, totaling Rp 18.4 million. All 23 claims were verified as eligible with no pending or disputed claims. The verification results were approved by the FKTP on September 18, 2023.

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    © All Rights Reserved
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    2 views2 pages

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    Uploaded by

    Klinik husada
    The document summarizes the claim verification results from BPJS Kesehatan for provider YUNITA PUSPASARI for August 2023. It shows that the total submitted claims were 23, totaling Rp 18.4 million. All 23 claims were verified as eligible with no pending or disputed claims. The verification results were approved by the FKTP on September 18, 2023.

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    of 2

    BPJS Kesehatan Cab.

    BANDAR LAMPUNG
    HASIL VERIFIKASI
    PENGAJUAN KLAIM TINGKAT PERTAMA

    Nomor FPK : P2308000029688

    Provider : YUNITA PUSPASARI

    Bulan Pelayanan : August 2023

    Pelayanan : RITP

    Pelayanan Verifikasi

    Total Data : 23 Total Data : 23 Layak : 23 Tidak Layak : 0

    Total Tagihan : Rp. 18.400.000 Total Tagihan : Rp. 18.400.000 Pending : 0 DIspute : 0

    NO TRANSAKSI NAMA PESERTA TGL MASUK TGL PULANG BIAYA STAT KETERANGAN

    B00058740823P000001 ROHIMAH (0002790189459) 05/08/2023 05/08/2023 Rp. 800.000 Layak

    B00058740823P000002 RIKA RAHMAYANI (0003085897386) 07/08/2023 08/08/2023 Rp. 800.000 Layak

    B00058740823P000003 SITI HALIMAH (0000994030132) 09/08/2023 10/08/2023 Rp. 800.000 Layak

    B00058740823P000005 RINA HERLIANA (0003097227903) 11/08/2023 12/08/2023 Rp. 800.000 Layak

    B00058740823P000006 NURHASANAH (0002635510893) 13/08/2023 13/08/2023 Rp. 800.000 Layak

    MEKA YULANDARI
    B00058740823P000007 15/08/2023 15/08/2023 Rp. 800.000 Layak
    (0002257671273)

    B00058740823P000008 PUTRI JULIANTI (0000337971453) 16/08/2023 16/08/2023 Rp. 800.000 Layak

    B00058740823P000009 MUTIA SARI (0000336059695) 17/08/2023 17/08/2023 Rp. 800.000 Layak

    B00058740823P000010 RIA OKTAVIA (0003505229976) 18/08/2023 19/08/2023 Rp. 800.000 Layak

    B00058740823P000011 MAISAH (0002523436626) 21/08/2023 22/08/2023 Rp. 800.000 Layak

    B00058740823P000012 KUSNITA (0002487024944) 22/08/2023 22/08/2023 Rp. 800.000 Layak

    B00058740823P000013 RIA ERDINA (0002264490167) 24/08/2023 24/08/2023 Rp. 800.000 Layak

    B00058740823P000014 EVRIYANA (0002075057515) 24/08/2023 25/08/2023 Rp. 800.000 Layak

    B00058740823P000015 KASMERI (0003508508518) 25/08/2023 26/08/2023 Rp. 800.000 Layak

    B00058740823P000016 RUMITA (0000336613937) 25/08/2023 26/08/2023 Rp. 800.000 Layak

    B00058740823P000017 RENA WATI (0000337176617) 26/08/2023 26/08/2023 Rp. 800.000 Layak

    B00058740823P000018 rosmilawati (0000336229751) 26/08/2023 26/08/2023 Rp. 800.000 Layak

    B00058740823P000019 YUYUN (0000336376293) 28/08/2023 29/08/2023 Rp. 800.000 Layak

    B00058740823P000020 RINI RIANI (0002834718884) 28/08/2023 29/08/2023 Rp. 800.000 Layak

    B00058740823P000021 ELI YANI (0000323818143) 29/08/2023 30/08/2023 Rp. 800.000 Layak

    B00058740823P000022 JUANAH (0003533645597) 29/08/2023 30/08/2023 Rp. 800.000 Layak

    B00058740823P000023 RENI ARISTA (0002593311941) 31/08/2023 31/08/2023 Rp. 800.000 Layak

    HASTIN BAROKAH MAROLINA


    B00058740823P000024 31/08/2023 31/08/2023 Rp. 800.000 Layak
    (0000035706789)

    Hasil Verifikasi Telah disetujui oleh FKTP


    Tanggal Selesai Verifikasi 18/09/2023 Pada Tanggal
    Verifikator BPJS Kesehatan, Pimpinan / Penanggung Jawab FKTP,
    Ari Winarto (......................................)

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