MONEV KLAIM YANKES PESERTA BPJS

REKAPITULASI PELAYANAN RAWAT INAP

BULAN FEBRUARI 2017

NO NO RM NAMA PASIEN UMUR THN

1 037371 MASHURI.TN 58TH

2 042435 SYAHKILLA NAURA MECCA.AN 5BLN
3 034128 MASRIFIYAH.NY 41TH
4 033475 SUNITI.NY 67TH
5 037395 AGUS MARGONO.TN 54TH
6 045467 ALIF DUTO WICAKSONO.TN 20TH
7 031598 SALAS SUDIONO.TN 73TH
8 042124 RARAS RAHAYU UTAMI.NY 24TH
9 043371 RISTIANI PUJI UTAMI.NY 30TH
10 041823 ULFA RIZKIYAH.NY 30TH
11 026099 SAMIRAH.NY 87TH
12 045405 PROFITA OKTAVINA.NY 31TH
13 045387 ROCHATUN.NY 71TH
14 038785 TITI RAKHMAWATI.NY 23TH
15 043589 KHUKMAH INAYATI.NY 20TH
16 043370 AYU NURLAELA.NY 27TH
17 042158 ISBIYATI.NY 41TH
18 045158 BUNGSU ASTRI RACHMADANI.NY 25TH
19 045706 KASMARI.TN 73TH
20 045583 EKA DARYANTI.NY 28TH
21 043591 LILIS INDAH WATI.NY 32TH
22 045662 YUSUP NUR ROHMAT.TN 31TH
23 045689 HERLINA ARISANTI.NY 31TH
24 036310 MARATUS SOLIKHA.NY 35TH
25 045648 NUR LAELA.NY 24TH
26 045697 LENI YUNITA.NY 22TH
27 044148 SITI PUWATI.NY 23TH
28 045434 SISWANTO.TN 37TH
29 045399 RIYANI.NY 35TH
30 045576 MUHAMMAD ABROR RIFANI.AN 1,5TH
 DIAGNOSA KLS TGL MSK TGL KLR LOS

DM, GASTRITIS, HT 3 11/02/2017 2/17/2017 6

DHF, PARATYPOID 2 1/26/2017 2/6/2017 11
DIARE, SEPSIS,GASTRITIS 1 2/10/2017 2/13/2017 3
STT PUNGGUNG, DM, HT 2 12/02/2017 15/02/2017 3
ASITES, DM II, PPOK 2 2/26/2017 28/02/2017 2
DHF 1 2/1/2017 2/4/2017 3
GASTRITIS, VIRAL INFEKSI 1 2/18/2017 2/24/2017 6
PARTUS DG KPD > 24JAM 3 2/4/2017 2/7/2017 3
PARTUS DENGAN KPD < 24 JAM 1 01/02/2017 2/4/2017 3
PARTUS SPONTAN DG PER 2 2/16/2017 2/17/2017 1
CHF, CKD, DM 1 2/17/2017 2/21/2017 4
HAMIL 7-8 MINGGU DENGAN AB INKOMPLIT 1 14/02/2017 2/16/2017 2
HEMATURIA, RETENSI URINE 1 1/29/2017 2/2/2017 4
PARTUS SC DENGAN PLASENTA LETAK RENDAH 1 12/02/2017 2/16/2017 4
PARTUS SC DENGAN LETAK OBLIGHT 1 2/24/2017 2/28/2017 4
PARTUS SC DENGAN BEKAS SC, ASTHMA 3 24/02/2017 2/27/2017 3
PARTUS SC DENGAN LETAK SUNGSANG 1 01/02/2017 2/4/2017 3
PARTUS SC DENGAN KPD 2 31/01/2017 2/4/2017 4
PPOK, CHF, POST TB 3 2/15/2017 2/20/2017 5
PARTUS SC DG OLIGOHIDRAMNION 3 15/02/2017 18/02/2017 3
PARTUS SC DG POP 2 2/2/2017 2/6/2017 4
VIRAL INFEKSI, GASTRITIS 2 2/20/2017 2/22/2017 2
PARTUS SC DG PLASENTA PREVIA TOTAL 3 14/02/2017 18/02/2017 4
HAMIL 20-21 MINGGU DENGAN BLIGHTED OVUM 2 13/02/2017 2/14/2017 1
PARTUS DG GEMELI TRIPLET 3 2/11/2017 2/14/2017 3
ANEMIA 3 2/14/2017 2/18/2017 4
PARTUS SC DENGAN OLIGOHIDROMION 3 09/02/2017 2/13/2017 4
STT CRURIS JOINT SINISTRA 2 09/02/2017 2/11/2017 2
PARTUS SC DENGAN OLIGOHIDROMION 3 30/01/2017 2/2/2017 3
ISK, MORBILI 2 08/02/2017 2/14/2017 6
 RAWAT INAP OBAT / RESEP

DPJP KLAIM BIAYA

JML KS JML HR RWT Ks
DISETUJUI (Rp)

DR.YUFRO,SPPD Rp 3,259,000 1 4.0 1,850,000 1

DR.RUWIYANTO.SPA Rp 1,740,700 1 12.0 Rp 3,125,000 1
DR.YUFRO,SPPD Rp 1,556,800 1 4.0 1,771,750 1
DR.ARIO.SPB Rp 3,986,400 1 3.5 1,055,000 1
DR.ARIO.SPB Rp 1,904,100 1 3.0 Rp 1,370,000 1
DR.IDHAM,SPPD Rp 1,509,900 1 3.0 1,366,875 1
DR.YUFRO,SPPD Rp 4,165,000 1 6.5 2,645,625 1
DR.OCTAVIANA,SPOG Rp 4,422,400 1 4.5 Rp 1,258,750 1
DR.OKTAVIANA.SPOG Rp 6,191,300 1 3.5 1,912,875 1
DR.OKTAVIANA.SPDG Rp 2,147,000 1 2.0 1,117,500 1
DR.MIN ATHOILAH.SPJP Rp 3,240,100 1 4.5 2,431,250 1
DR.OKTAVIANA.SPOG Rp 2,084,700 1 2.0 928,750 1
DR.YUFRO,SPPD Rp 2,603,900 1 4.5 2,116,875 1
DR.OKTAVIANA.SPOG Rp 6,191,300 1 4.0 2,079,125 1
DR.OKTAVIANA.SPOG Rp 6,191,300 1 4.5 2,215,375 1
DR.OKTAVIANA.SPOG Rp 4,678,500 1 3.4 1,281,200 1
DR.OKTAVIANA.SPOG Rp 6,191,300 1 3.5 1,992,250 1
DR.OKTAVIANA.SPDG Rp 5,306,800 1 4.5 1,516,000 1
DR.YUSFI,SPP Rp 2,010,700 1 5.0 1,362,500 1
DR.OCTAVIANA,SPOG Rp 4,422,400 1 4.5 1,231,250 1
DR.OKTAVIANA.SPDG Rp 5,306,800 1 4.5 1,435,000 1
DR.YUFRO,SPPD Rp 1,294,200 1 3.5 1,050,500 1
DR.OCTAVIANA,SPOG Rp 4,422,400 1 4.5 1,225,000 1
DR.OKTAVIANA.SPDG Rp 1,786,900 1 1.5 520,000 1
DR.OCTAVIANA,SPOG Rp 4,422,400 1 3.5 1,032,500 1
DR.IDHAM,SPPD Rp 1,956,800 1 4.0 1,170,000 1
DR.OKTAVIANA.SPOG Rp 4,422,400 1 4.5 1,379,950 1
DR.ARIO.SPB Rp 3,986,400 1 2.0 610,000 1
DR.OKTAVIANA.SPOG Rp 4,422,400 1 3.5 1,187,450 1
DR.RUWIYANTO.SPA Rp 2,397,600 1 7.0 1,885,000 1
OBAT / RESEP OPERASI PERSALINAN PATOLOGIS/D
TANPA
BIAYA BAHP BIAYA
KECIL SEDANG BESAR KHUSUS TINDAKAN
DISETUJUI (Rp) DISETUJUI (Rp)
PERSALINAN NORMAL

3,838,300 110,700
1,437,000 171,000
1,806,400 73,850
1,068,600 58,400 1 3,199,000
1,467,100 68,300
648,700 64,425
1,638,900 112,475
1,279,700 141,350
1,212,800 129,825
253,900 126,600 1
994,300 114,450
343,700 81,300 1 1,836,250
735,500 91,625
1,294,500 155,875
1,142,900 161,225
1,455,400 121,900
1,354,800 132,450
1,441,100 139,150
987,900 85,600
1,484,400 147,150
1,276,300 138,950
660,600 64,900
1,404,600 138,200
374,900 67,350 1 1,602,750
1,275,000 120,300
470,500 81,500
1,176,500 140,050
462,000 70,950 1 3,382,750
1,358,800 115,250
815,800 113,200
PERSALINAN PATOLOGIS/DG KOMPLIKASI LAB RADIOLOGI

BIAYA EKG
JML HR RWT KUNJ BIAYA
SC DISETUJUI KUNJ BIAYA KUNJ

5 1,113,000 1 78,000 1
8 1,137,000
2 218,000
2 241,000 1 78,000 1
4 511,000 1 243,000
5 1,090,000
1 565,000 1 78,000
1 4.5 2,482,200 3 463,000
1 3.5 3,704,500 1 300,000
2 1,464,000 1 533,000
6 621,000 1 78,000 1
1 300,000
2 309,000 2 662,000 1
1 4 3,655,500 1 300,000
1 4.5 3,655,500 1 300,000
1 3.5 2,260,500 1 486,000
1 3.4 3,655,500 1 300,000
1 4.5 3,128,750 1 300,000
2 368,000 1 78,000 2
1 4.5 2,482,200 1 300,000
1 4.5 3,319,750 1 300,000
2 664,000
1 4.5 2,437,200 1 300,000
1 300,000
1 3.5 2,707,200 1 300,000
1 788,000 1
1 4.5 2,308,500 1 300,000
1 344,000
1 3.5 2,308,500 1 300,000
4 456,000
 ELEKTROMEDIK TRANSFUSI DARAH

EKG USG LAIN-LAIN SUB TOTAL BIAYA

KS
DISETUJUI (Rp)
BIAYA KUNJ BIAYA KUNJ BIAYA

45,000 48 485,000 1,721,000

1,137,000
218,000
90,000 409,000
754,000
1,090,000
643,000 2 720,000
1 25,000 488,000 1 360,000
1 35,000 335,000 1 360,000
2 95,000 628,000
45,000 1 396,000 1,140,000
300,000
45,000 1,016,000
1 35,000 335,000
1 35,000 335,000
1 25,000 511,000 1 360,000
1 35,000 335,000
1 35,000 335,000
90,000 1 288,000 824,000
1 25,000 325,000
1 35,000 335,000
664,000
1 25,000 325,000
1 15,000 315,000
1 25,000 325,000
45,000 1 75,000 908,000 1 360,000
1 25,000 325,000
344,000
1 25,000 325,000
456,000
 TOTAL BIAYA SELISIH KETERANGAN

Rp 7,520,000 Rp (4,261,000) (-)

Rp 5,870,000 Rp (4,129,300) (-)
Rp 3,870,000 Rp (2,313,200) (-)
Rp 5,790,000 Rp (1,803,600) (-)
Rp 3,659,400 Rp (1,755,300) (-)
Rp 3,170,000 Rp (1,660,100) (-)
Rp 5,760,000 Rp (1,595,000) (-)
Rp 6,010,000 Rp (1,587,600) (-)
Rp 7,655,000 Rp (1,463,700) (-)
Rp 3,590,000 Rp (1,443,000) (-)
Rp 4,680,000 Rp (1,439,900) (-)
Rp 3,490,000 Rp (1,405,300) (-)
Rp 3,960,000 Rp (1,356,100) (-)
Rp 7,520,000 Rp (1,328,700) (-)
Rp 7,510,000 Rp (1,318,700) (-)
Rp 5,990,000 Rp (1,311,500) (-)
Rp 7,470,000 Rp (1,278,700) (-)
Rp 6,560,000 Rp (1,253,200) (-)
Rp 3,260,000 Rp (1,249,300) (-)
Rp 5,670,000 Rp (1,247,600) (-)
Rp 6,505,000 Rp (1,198,200) (-)
Rp 2,440,000 Rp (1,145,800) (-)
Rp 5,530,000 Rp (1,107,600) (-)
Rp 2,880,000 Rp (1,093,100) (-)
Rp 5,460,000 Rp (1,037,600) (-)
Rp 2,990,000 Rp (1,033,200) (-)
Rp 5,330,000 Rp (907,600) (-)
Rp 4,869,700 Rp (883,300) (-)
Rp 5,295,000 Rp (872,600) (-)
Rp 3,270,000 Rp (872,400) (-)
Rp 1,334,400
Rp 6,735,500
Rp 5,614,200
Rp 2,586,400
Rp 5,606,500
Rp 2,586,400
Rp 5,606,500
Rp 5,306,800
Rp 2,270,200
Rp 2,586,400