Nama RS : RSU LHOKSEUMAWE LAPORAN HASIL VERIFIKASI SECARA ADMINISTRASI

Tingkat Pelayanan : RITL

Tgl.Pelayanan : 01-05-2017 s/d 31-05-2017
Status : Pending

No No SEP Tgl Msk Tgl Plg No.Kartu Nm Pst LP Kd CBGs Nm Cbgs

1 0107R00105170005896 11-05-2017 12-05-2017 0002032420037 mariani P C-4-13-I CHEMOTHERAPY

2 0107R00105170007244 15-05-2017 16-05-2017 0000228941122 ANWAR L C-4-13-I CHEMOTHERAPY
3 0107R00105170007844 16-05-2017 17-05-2017 0000229574193 NURASNAH P C-4-13-I CHEMOTHERAPY
4 0107R00105170008528 17-05-2017 17-05-2017 0000221477589 M YUSUF L C-4-13-I CHEMOTHERAPY
5 0107R00105170010427 19-05-2017 19-05-2017 0000003201581 FUADI,s kep L C-4-13-I CHEMOTHERAPY

Mengetahui
BPJS KESEHATAN

Meutia Sari
HASIL VERIFIKASI SECARA ADMINISTRASI

Nm Cbgs CMG Tarif Gruper Tarif Biaya Klaim Tarip

(59) (Grp+CMG) (59+CMG)
CHEMOTHERAPY SA: Rp.0,SP: Rp.0,SR:Rp.0,SI: 2,177,700 2,177,700 2,177,700 2,177,700
Rp.0,SD: Rp.0
CHEMOTHERAPY SA: Rp.0,SP: Rp.0,SR:Rp.0,SI: 2,177,700 2,177,700 2,177,700 2,177,700
Rp.0,SD: Rp.0
CHEMOTHERAPY SA: Rp.0,SP: Rp.0,SR:Rp.0,SI: 2,177,700 2,177,700 2,177,700 2,177,700
Rp.0,SD: Rp.0
CHEMOTHERAPY SA: Rp.0,SP: Rp.0,SR:Rp.0,SI: 2,177,700 2,177,700 2,177,700 2,177,700
Rp.0,SD: Rp.0
CHEMOTHERAPY SA: Rp.0,SP: Rp.0,SR:Rp.0,SI: 3,048,800 3,048,800 3,048,800 3,048,800
Rp.0,SD: Rp.0
TOTAL 11,759,600 11,759,600 11759600 11759600

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