Hal.

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RINCIAN DATA HASIL VERIFIKASI

Nama RS : RSUD BANGKA TENGAH - KAB. BANGKA TENGAH

Tingkat Pelayanan : RITL
Bulan Pelayanan : September 2021

No No.SEP Tgl. Verifikasi Biaya

Riil RS Diajukan Disetujui
1 0617R0010821V001357 2021-11-04 3,923,129 2,995,400 2,995,400
2 0617R0010821V001383 2021-11-04 4,864,759 3,221,100 3,221,100
3 0617R0010821V001465 2021-11-04 3,587,089 6,321,400 6,321,400
4 0617R0010821V001476 2021-11-04 6,741,790 2,772,100 2,772,100
5 0617R0010821V001478 2021-11-04 2,594,899 3,038,200 3,038,200
6 0617R0010821V001522 2021-11-04 3,864,715 4,047,700 4,047,700
7 0617R0010821V001534 2021-11-04 1,177,000 3,366,300 3,366,300
8 0617R0010921V000039 2021-11-04 9,158,502 4,888,200 4,888,200
9 0617R0010921V000045 2021-11-04 2,442,989 2,220,600 2,220,600
10 0617R0010921V000071 2021-11-04 3,078,024 1,563,400 1,563,400
11 0617R0010921V000073 2021-11-04 2,037,234 934,700 934,700
12 0617R0010921V000084 2021-11-04 1,640,735 3,887,600 3,887,600
13 0617R0010921V000126 2021-11-04 1,224,000 3,366,300 3,366,300
14 0617R0010921V000151 2021-11-04 2,025,114 3,370,600 3,370,600
15 0617R0010921V000159 2021-11-04 13,132,888 4,888,200 4,888,200
16 0617R0010921V000169 2021-11-04 8,033,290 4,447,800 4,447,800
17 0617R0010921V000181 2021-11-04 3,085,713 1,563,400 1,563,400
18 0617R0010921V000253 2021-11-04 6,370,980 4,911,600 4,911,600
19 0617R0010921V000261 2021-11-04 1,024,275 3,366,300 3,366,300
20 0617R0010921V000262 2021-11-04 1,542,932 4,423,300 4,423,300
21 0617R0010921V000311 2021-11-04 11,467,976 4,888,200 4,888,200
22 0617R0010921V000336 2021-11-04 3,379,121 2,220,500 2,220,500
23 0617R0010921V000343 2021-11-04 7,594,234 1,677,000 1,677,000
24 0617R0010921V000358 2021-11-04 3,766,886 3,366,300 3,366,300
25 0617R0010921V000365 2021-11-04 12,511,390 5,163,200 5,163,200
26 0617R0010921V000406 2021-11-04 9,501,952 3,880,400 3,880,400
27 0617R0010921V000425 2021-11-04 3,337,387 4,888,200 4,888,200
28 0617R0010921V000428 2021-11-04 4,540,652 1,876,100 1,876,100
29 0617R0010921V000475 2021-11-04 3,267,558 4,888,200 4,888,200
30 0617R0010921V000479 2021-11-04 3,737,696 3,370,600 3,370,600
31 0617R0010921V000487 2021-11-04 3,635,384 1,563,400 1,563,400
32 0617R0010921V000514 2021-11-04 4,239,048 3,879,100 3,879,100
 Hal.2/3

RINCIAN DATA HASIL VERIFIKASI

Nama RS : RSUD BANGKA TENGAH - KAB. BANGKA TENGAH

Tingkat Pelayanan : RITL
Bulan Pelayanan : September 2021

33 0617R0010921V000629 2021-11-04 2,759,744 2,023,800 2,023,800

34 0617R0010921V000630 2021-11-04 9,234,987 2,071,900 2,071,900
35 0617R0010921V000660 2021-11-04 2,710,533 3,886,400 3,886,400
36 0617R0010921V000676 2021-11-04 3,189,420 1,563,400 1,563,400
37 0617R0010921V000686 2021-11-04 2,882,757 1,850,400 1,850,400
38 0617R0010921V000739 2021-11-04 1,878,409 2,293,800 2,293,800
39 0617R0010921V000784 2021-11-04 4,671,884 2,268,200 2,268,200
40 0617R0010921V000788 2021-11-04 4,296,441 1,563,400 1,563,400
41 0617R0010921V000800 2021-11-04 11,831,648 5,163,200 5,163,200
42 0617R0010921V000871 2021-11-04 8,379,570 4,888,200 4,888,200
43 0617R0010921V000872 2021-11-04 2,572,010 3,887,600 3,887,600
44 0617R0010921V000884 2021-11-04 976,000 3,366,300 3,366,300
45 0617R0010921V000951 2021-11-04 5,634,165 4,512,000 4,512,000
46 0617R0010921V000952 2021-11-04 3,017,731 1,748,800 1,748,800
47 0617R0010921V000954 2021-11-04 2,331,515 1,798,700 1,798,700
48 0617R0010921V000957 2021-11-04 2,554,267 2,138,200 2,138,200
49 0617R0010921V000995 2021-11-04 836,000 3,366,300 3,366,300
50 0617R0010921V001002 2021-11-04 3,778,123 6,195,900 6,195,900
51 0617R0010921V001048 2021-11-04 7,803,119 3,886,400 3,886,400
52 0617R0010921V001056 2021-11-04 1,490,264 2,023,800 2,023,800
53 0617R0010921V001099 2021-11-04 1,394,000 3,366,300 3,366,300
54 0617R0010921V001113 2021-11-04 3,672,419 5,865,800 5,865,800
55 0617R0010921V001116 2021-11-04 4,689,960 3,142,600 3,142,600
56 0617R0010921V001154 2021-11-04 3,045,127 4,888,200 4,888,200
57 0617R0010921V001162 2021-11-04 2,881,066 1,563,400 1,563,400
58 0617R0010921V001230 2021-11-04 916,000 3,366,300 3,366,300
59 0617R0010921V001232 2021-11-04 1,671,632 1,992,400 1,992,400
60 0617R0010921V001234 2021-11-04 2,525,126 2,541,200 2,541,200
61 0617R0010921V001240 2021-11-04 4,048,435 6,321,400 6,321,400
62 0617R0010921V001280 2021-11-04 2,082,358 2,664,700 2,664,700
63 0617R0010921V001289 2021-11-04 11,161,658 4,888,200 4,888,200
64 0617R0010921V001329 2021-11-04 2,434,206 3,966,500 3,966,500
65 0617R0010921V001332 2021-11-04 1,389,313 3,366,300 3,366,300
TOTAL 277,269,228 219,685,400 219,685,400
 Hal.3/3

RINCIAN DATA HASIL VERIFIKASI

Nama RS : RSUD BANGKA TENGAH - KAB. BANGKA TENGAH

Tingkat Pelayanan : RITL
Bulan Pelayanan : September 2021

RESUME
Total Bea.Diajukan : 219,685,400
Total Bea.Disetujui : 219,685,400

Menyetujui Mengetahui
Direktur RS BPJS KESEHATAN

dr. Lismayoni