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  • Umpan Balik Hasil Verifikasi

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    DONI PRAMANTO
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    This document is a verification report from a hospital in Way Kanan Regency for the month of October 2018. It lists 100 patient cases with their verification numbers, dates, proposed costs, and approved costs. For most cases, the proposed and approved costs were identical. The costs ranged from Rp. 192,100 to Rp. 314,100 depending on the case.

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    This document is a verification report from a hospital in Way Kanan Regency for the month of October 2018. It lists 100 patient cases with their verification numbers, dates, proposed costs, and approved costs. For most cases, the proposed and approved costs were identical. The costs ranged from Rp. 192,100 to Rp. 314,100 depending on the case.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
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    9 views18 pages

    Umpan Balik Hasil Verifikasi

    Uploaded by

    DONI PRAMANTO
    This document is a verification report from a hospital in Way Kanan Regency for the month of October 2018. It lists 100 patient cases with their verification numbers, dates, proposed costs, and approved costs. For most cases, the proposed and approved costs were identical. The costs ranged from Rp. 192,100 to Rp. 314,100 depending on the case.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as pdf or txt
    of 18

    Hal.

    1/18

    UMPAN BALIK HASIL VERIFIKASI

    Nama RS : RUMAH SAKIT BUNDA - KAB. WAY KANAN


    Tingkat Pelayanan : RJTL
    Bulan Pelayanan : Oktober 2018

    No No.SEP Tgl. Verifikasi Biaya


    Diajukan Disetujui
    1 0104R0051018V000002 2018-12-03 194,900 194,900
    2 0104R0051018V000005 2018-12-03 194,900 194,900
    3 0104R0051018V000006 2018-12-03 194,900 194,900
    4 0104R0051018V000008 2018-12-03 194,900 194,900
    5 0104R0051018V000014 2018-12-03 314,100 314,100
    6 0104R0051018V000017 2018-12-03 314,100 314,100
    7 0104R0051018V000018 2018-12-03 314,100 314,100
    8 0104R0051018V000019 2018-12-03 314,100 314,100
    9 0104R0051018V000027 2018-12-03 192,100 192,100
    10 0104R0051018V000028 2018-12-03 192,100 192,100
    11 0104R0051018V000029 2018-12-03 192,100 192,100
    12 0104R0051018V000031 2018-12-03 192,100 192,100
    13 0104R0051018V000032 2018-12-03 192,100 192,100
    14 0104R0051018V000033 2018-12-03 192,100 192,100
    15 0104R0051018V000034 2018-12-03 192,100 192,100
    16 0104R0051018V000035 2018-12-03 192,100 192,100
    17 0104R0051018V000036 2018-12-03 192,100 192,100
    18 0104R0051018V000037 2018-12-03 192,100 192,100
    19 0104R0051018V000038 2018-12-03 192,100 192,100
    20 0104R0051018V000039 2018-12-03 192,100 192,100
    21 0104R0051018V000040 2018-12-03 192,100 192,100
    22 0104R0051018V000041 2018-12-03 192,100 192,100
    23 0104R0051018V000042 2018-12-03 192,100 192,100
    24 0104R0051018V000043 2018-12-03 192,100 192,100
    25 0104R0051018V000044 2018-12-03 193,500 193,500
    26 0104R0051018V000045 2018-12-03 192,100 192,100
    27 0104R0051018V000046 2018-12-03 192,100 192,100
    28 0104R0051018V000047 2018-12-03 192,100 192,100
    29 0104R0051018V000048 2018-12-03 192,100 192,100
    30 0104R0051018V000049 2018-12-03 192,100 192,100
    31 0104R0051018V000050 2018-12-03 192,100 192,100
    32 0104R0051018V000051 2018-12-03 192,100 192,100
    Hal.2/18

    UMPAN BALIK HASIL VERIFIKASI

    Nama RS : RUMAH SAKIT BUNDA - KAB. WAY KANAN


    Tingkat Pelayanan : RJTL
    Bulan Pelayanan : Oktober 2018

    33 0104R0051018V000052 2018-12-03 192,100 192,100


    34 0104R0051018V000053 2018-12-03 192,100 192,100
    35 0104R0051018V000054 2018-12-03 192,100 192,100
    36 0104R0051018V000055 2018-12-03 192,100 192,100
    37 0104R0051018V000056 2018-12-03 192,100 192,100
    38 0104R0051018V000057 2018-12-03 192,100 192,100
    39 0104R0051018V000058 2018-12-03 192,100 192,100
    40 0104R0051018V000059 2018-12-03 192,100 192,100
    41 0104R0051018V000060 2018-12-03 192,100 192,100
    42 0104R0051018V000061 2018-12-03 192,100 192,100
    43 0104R0051018V000062 2018-12-03 192,100 192,100
    44 0104R0051018V000063 2018-12-03 192,100 192,100
    45 0104R0051018V000064 2018-12-03 192,100 192,100
    46 0104R0051018V000065 2018-12-03 192,100 192,100
    47 0104R0051018V000066 2018-12-03 192,100 192,100
    48 0104R0051018V000067 2018-12-03 192,100 192,100
    49 0104R0051018V000068 2018-12-03 192,100 192,100
    50 0104R0051018V000069 2018-12-03 192,100 192,100
    51 0104R0051018V000071 2018-12-03 192,100 192,100
    52 0104R0051018V000072 2018-12-03 192,100 192,100
    53 0104R0051018V000073 2018-12-03 192,100 192,100
    54 0104R0051018V000074 2018-12-03 192,100 192,100
    55 0104R0051018V000075 2018-12-03 192,100 192,100
    56 0104R0051018V000076 2018-12-03 192,100 192,100
    57 0104R0051018V000077 2018-12-03 192,100 192,100
    58 0104R0051018V000078 2018-12-03 192,100 192,100
    59 0104R0051018V000079 2018-12-03 192,100 192,100
    60 0104R0051018V000080 2018-12-03 192,100 192,100
    61 0104R0051018V000081 2018-12-03 192,100 192,100
    62 0104R0051018V000082 2018-12-03 192,100 192,100
    63 0104R0051018V000086 2018-12-03 192,100 192,100
    64 0104R0051018V000087 2018-12-03 192,100 192,100
    65 0104R0051018V000088 2018-12-03 192,100 192,100
    66 0104R0051018V000089 2018-12-03 193,500 193,500
    Hal.3/18

    UMPAN BALIK HASIL VERIFIKASI

    Nama RS : RUMAH SAKIT BUNDA - KAB. WAY KANAN


    Tingkat Pelayanan : RJTL
    Bulan Pelayanan : Oktober 2018

    67 0104R0051018V000090 2018-12-03 192,100 192,100


    68 0104R0051018V000091 2018-12-03 192,100 192,100
    69 0104R0051018V000092 2018-12-03 192,100 192,100
    70 0104R0051018V000093 2018-12-03 192,100 192,100
    71 0104R0051018V000094 2018-12-03 192,100 192,100
    72 0104R0051018V000095 2018-12-03 192,100 192,100
    73 0104R0051018V000096 2018-12-03 194,900 194,900
    74 0104R0051018V000097 2018-12-03 192,100 192,100
    75 0104R0051018V000098 2018-12-03 314,100 314,100
    76 0104R0051018V000099 2018-12-03 192,100 192,100
    77 0104R0051018V000102 2018-12-03 192,100 192,100
    78 0104R0051018V000103 2018-12-03 192,100 192,100
    79 0104R0051018V000104 2018-12-03 192,100 192,100
    80 0104R0051018V000105 2018-12-03 192,100 192,100
    81 0104R0051018V000106 2018-12-03 192,100 192,100
    82 0104R0051018V000107 2018-12-03 192,100 192,100
    83 0104R0051018V000108 2018-12-03 194,900 194,900
    84 0104R0051018V000109 2018-12-03 194,900 194,900
    85 0104R0051018V000110 2018-12-03 192,100 192,100
    86 0104R0051018V000111 2018-12-03 192,100 192,100
    87 0104R0051018V000112 2018-12-03 192,100 192,100
    88 0104R0051018V000113 2018-12-03 192,100 192,100
    89 0104R0051018V000114 2018-12-03 192,100 192,100
    90 0104R0051018V000115 2018-12-03 192,100 192,100
    91 0104R0051018V000116 2018-12-03 192,100 192,100
    92 0104R0051018V000117 2018-12-03 192,100 192,100
    93 0104R0051018V000118 2018-12-03 192,100 192,100
    94 0104R0051018V000119 2018-12-03 192,100 192,100
    95 0104R0051018V000120 2018-12-03 194,900 194,900
    96 0104R0051018V000121 2018-12-03 192,100 192,100
    97 0104R0051018V000122 2018-12-03 192,100 192,100
    98 0104R0051018V000123 2018-12-03 193,500 193,500
    99 0104R0051018V000124 2018-12-03 192,100 192,100
    100 0104R0051018V000125 2018-12-03 192,100 192,100
    Hal.4/18

    UMPAN BALIK HASIL VERIFIKASI

    Nama RS : RUMAH SAKIT BUNDA - KAB. WAY KANAN


    Tingkat Pelayanan : RJTL
    Bulan Pelayanan : Oktober 2018

    101 0104R0051018V000126 2018-12-03 192,100 192,100


    102 0104R0051018V000139 2018-12-03 192,100 192,100
    103 0104R0051018V000141 2018-12-03 192,100 192,100
    104 0104R0051018V000142 2018-12-03 192,100 192,100
    105 0104R0051018V000143 2018-12-03 192,100 192,100
    106 0104R0051018V000144 2018-12-03 192,100 192,100
    107 0104R0051018V000145 2018-12-03 192,100 192,100
    108 0104R0051018V000146 2018-12-03 192,100 192,100
    109 0104R0051018V000147 2018-12-03 192,100 192,100
    110 0104R0051018V000148 2018-12-03 192,100 192,100
    111 0104R0051018V000149 2018-12-03 192,100 192,100
    112 0104R0051018V000150 2018-12-03 192,100 192,100
    113 0104R0051018V000151 2018-12-03 194,900 194,900
    114 0104R0051018V000152 2018-12-03 192,100 192,100
    115 0104R0051018V000153 2018-12-03 192,100 192,100
    116 0104R0051018V000154 2018-12-03 192,100 192,100
    117 0104R0051018V000155 2018-12-03 192,100 192,100
    118 0104R0051018V000157 2018-12-03 192,100 192,100
    119 0104R0051018V000158 2018-12-03 194,900 194,900
    120 0104R0051018V000159 2018-12-03 192,100 192,100
    121 0104R0051018V000161 2018-12-03 314,100 314,100
    122 0104R0051018V000163 2018-12-03 314,100 314,100
    123 0104R0051018V000164 2018-12-03 192,100 192,100
    124 0104R0051018V000165 2018-12-03 192,100 192,100
    125 0104R0051018V000166 2018-12-03 192,100 192,100
    126 0104R0051018V000170 2018-12-03 314,100 314,100
    127 0104R0051018V000171 2018-12-03 192,100 192,100
    128 0104R0051018V000172 2018-12-03 192,100 192,100
    129 0104R0051018V000173 2018-12-03 192,100 192,100
    130 0104R0051018V000174 2018-12-03 194,900 194,900
    131 0104R0051018V000186 2018-12-03 192,100 192,100
    132 0104R0051018V000187 2018-12-03 314,100 314,100
    133 0104R0051018V000188 2018-12-03 194,900 194,900
    134 0104R0051018V000190 2018-12-03 192,100 192,100
    Hal.5/18

    UMPAN BALIK HASIL VERIFIKASI

    Nama RS : RUMAH SAKIT BUNDA - KAB. WAY KANAN


    Tingkat Pelayanan : RJTL
    Bulan Pelayanan : Oktober 2018

    135 0104R0051018V000191 2018-12-03 194,900 194,900


    136 0104R0051018V000192 2018-12-03 192,100 192,100
    137 0104R0051018V000194 2018-12-03 193,500 193,500
    138 0104R0051018V000197 2018-12-03 194,900 194,900
    139 0104R0051018V000200 2018-12-03 192,100 192,100
    140 0104R0051018V000203 2018-12-03 192,100 192,100
    141 0104R0051018V000204 2018-12-03 194,900 194,900
    142 0104R0051018V000205 2018-12-03 194,900 194,900
    143 0104R0051018V000206 2018-12-03 143,700 143,700
    144 0104R0051018V000207 2018-12-03 194,900 194,900
    145 0104R0051018V000208 2018-12-03 194,900 194,900
    146 0104R0051018V000209 2018-12-03 314,100 314,100
    147 0104R0051018V000211 2018-12-03 193,500 193,500
    148 0104R0051018V000212 2018-12-03 192,100 192,100
    149 0104R0051018V000213 2018-12-03 192,100 192,100
    150 0104R0051018V000214 2018-12-03 192,100 192,100
    151 0104R0051018V000215 2018-12-03 192,100 192,100
    152 0104R0051018V000216 2018-12-03 192,100 192,100
    153 0104R0051018V000217 2018-12-03 192,100 192,100
    154 0104R0051018V000218 2018-12-03 192,100 192,100
    155 0104R0051018V000219 2018-12-03 192,100 192,100
    156 0104R0051018V000220 2018-12-03 552,100 552,100
    157 0104R0051018V000221 2018-12-03 306,600 306,600
    158 0104R0051018V000223 2018-12-03 192,100 192,100
    159 0104R0051018V000226 2018-12-03 192,100 192,100
    160 0104R0051018V000233 2018-12-03 192,100 192,100
    161 0104R0051018V000234 2018-12-03 134,100 134,100
    162 0104R0051018V000235 2018-12-03 192,100 192,100
    163 0104R0051018V000236 2018-12-03 192,100 192,100
    164 0104R0051018V000237 2018-12-03 192,100 192,100
    165 0104R0051018V000238 2018-12-03 192,100 192,100
    166 0104R0051018V000239 2018-12-03 192,100 192,100
    167 0104R0051018V000240 2018-12-03 192,100 192,100
    168 0104R0051018V000241 2018-12-03 192,100 192,100
    Hal.6/18

    UMPAN BALIK HASIL VERIFIKASI

    Nama RS : RUMAH SAKIT BUNDA - KAB. WAY KANAN


    Tingkat Pelayanan : RJTL
    Bulan Pelayanan : Oktober 2018

    169 0104R0051018V000242 2018-12-03 192,100 192,100


    170 0104R0051018V000243 2018-12-03 192,100 192,100
    171 0104R0051018V000244 2018-12-03 192,100 192,100
    172 0104R0051018V000246 2018-12-03 192,100 192,100
    173 0104R0051018V000247 2018-12-03 192,100 192,100
    174 0104R0051018V000248 2018-12-03 192,100 192,100
    175 0104R0051018V000249 2018-12-03 192,100 192,100
    176 0104R0051018V000250 2018-12-03 192,100 192,100
    177 0104R0051018V000251 2018-12-03 192,100 192,100
    178 0104R0051018V000252 2018-12-03 192,100 192,100
    179 0104R0051018V000253 2018-12-03 192,100 192,100
    180 0104R0051018V000254 2018-12-03 192,100 192,100
    181 0104R0051018V000255 2018-12-03 192,100 192,100
    182 0104R0051018V000256 2018-12-03 192,100 192,100
    183 0104R0051018V000257 2018-12-03 192,100 192,100
    184 0104R0051018V000258 2018-12-03 192,100 192,100
    185 0104R0051018V000259 2018-12-03 192,100 192,100
    186 0104R0051018V000260 2018-12-03 193,500 193,500
    187 0104R0051018V000261 2018-12-03 193,500 193,500
    188 0104R0051018V000262 2018-12-03 192,100 192,100
    189 0104R0051018V000263 2018-12-03 192,100 192,100
    190 0104R0051018V000264 2018-12-03 192,100 192,100
    191 0104R0051018V000265 2018-12-03 192,100 192,100
    192 0104R0051018V000267 2018-12-03 192,100 192,100
    193 0104R0051018V000268 2018-12-03 192,100 192,100
    194 0104R0051018V000269 2018-12-03 192,100 192,100
    195 0104R0051018V000270 2018-12-03 192,100 192,100
    196 0104R0051018V000271 2018-12-03 192,100 192,100
    197 0104R0051018V000272 2018-12-03 192,100 192,100
    198 0104R0051018V000273 2018-12-03 192,100 192,100
    199 0104R0051018V000274 2018-12-03 192,100 192,100
    200 0104R0051018V000275 2018-12-03 192,100 192,100
    201 0104R0051018V000276 2018-12-03 192,100 192,100
    202 0104R0051018V000277 2018-12-03 192,100 192,100
    Hal.7/18

    UMPAN BALIK HASIL VERIFIKASI

    Nama RS : RUMAH SAKIT BUNDA - KAB. WAY KANAN


    Tingkat Pelayanan : RJTL
    Bulan Pelayanan : Oktober 2018

    203 0104R0051018V000278 2018-12-03 256,500 256,500


    204 0104R0051018V000279 2018-12-03 192,100 192,100
    205 0104R0051018V000280 2018-12-03 192,100 192,100
    206 0104R0051018V000281 2018-12-03 192,100 192,100
    207 0104R0051018V000282 2018-12-03 192,100 192,100
    208 0104R0051018V000283 2018-12-03 192,100 192,100
    209 0104R0051018V000284 2018-12-03 192,100 192,100
    210 0104R0051018V000285 2018-12-03 192,100 192,100
    211 0104R0051018V000286 2018-12-03 192,100 192,100
    212 0104R0051018V000287 2018-12-03 192,100 192,100
    213 0104R0051018V000288 2018-12-03 192,100 192,100
    214 0104R0051018V000289 2018-12-03 192,100 192,100
    215 0104R0051018V000290 2018-12-03 192,100 192,100
    216 0104R0051018V000291 2018-12-03 192,100 192,100
    217 0104R0051018V000292 2018-12-03 192,100 192,100
    218 0104R0051018V000293 2018-12-03 192,100 192,100
    219 0104R0051018V000294 2018-12-03 192,100 192,100
    220 0104R0051018V000295 2018-12-03 192,100 192,100
    221 0104R0051018V000296 2018-12-03 192,100 192,100
    222 0104R0051018V000297 2018-12-03 192,100 192,100
    223 0104R0051018V000298 2018-12-03 192,100 192,100
    224 0104R0051018V000299 2018-12-03 192,100 192,100
    225 0104R0051018V000300 2018-12-03 192,100 192,100
    226 0104R0051018V000301 2018-12-03 193,500 193,500
    227 0104R0051018V000302 2018-12-03 192,100 192,100
    228 0104R0051018V000303 2018-12-03 192,100 192,100
    229 0104R0051018V000304 2018-12-03 192,100 192,100
    230 0104R0051018V000305 2018-12-03 192,100 192,100
    231 0104R0051018V000306 2018-12-03 192,100 192,100
    232 0104R0051018V000307 2018-12-03 192,100 192,100
    233 0104R0051018V000308 2018-12-03 192,100 192,100
    234 0104R0051018V000309 2018-12-03 192,100 192,100
    235 0104R0051018V000310 2018-12-03 192,100 192,100
    236 0104R0051018V000311 2018-12-03 192,100 192,100
    Hal.8/18

    UMPAN BALIK HASIL VERIFIKASI

    Nama RS : RUMAH SAKIT BUNDA - KAB. WAY KANAN


    Tingkat Pelayanan : RJTL
    Bulan Pelayanan : Oktober 2018

    237 0104R0051018V000312 2018-12-03 194,900 194,900


    238 0104R0051018V000313 2018-12-03 194,900 194,900
    239 0104R0051018V000314 2018-12-03 192,100 192,100
    240 0104R0051018V000315 2018-12-03 192,100 192,100
    241 0104R0051018V000316 2018-12-03 314,100 314,100
    242 0104R0051018V000317 2018-12-03 192,100 192,100
    243 0104R0051018V000318 2018-12-03 194,900 194,900
    244 0104R0051018V000319 2018-12-03 145,200 145,200
    245 0104R0051018V000325 2018-12-03 192,100 192,100
    246 0104R0051018V000326 2018-12-03 192,100 192,100
    247 0104R0051018V000327 2018-12-03 192,100 192,100
    248 0104R0051018V000328 2018-12-03 192,100 192,100
    249 0104R0051018V000329 2018-12-03 192,100 192,100
    250 0104R0051018V000330 2018-12-03 192,100 192,100
    251 0104R0051018V000331 2018-12-03 192,100 192,100
    252 0104R0051018V000332 2018-12-03 192,100 192,100
    253 0104R0051018V000333 2018-12-03 192,100 192,100
    254 0104R0051018V000334 2018-12-03 192,100 192,100
    255 0104R0051018V000335 2018-12-03 192,100 192,100
    256 0104R0051018V000336 2018-12-03 192,100 192,100
    257 0104R0051018V000338 2018-12-03 192,100 192,100
    258 0104R0051018V000339 2018-12-03 192,100 192,100
    259 0104R0051018V000340 2018-12-03 192,100 192,100
    260 0104R0051018V000341 2018-12-03 192,100 192,100
    261 0104R0051018V000342 2018-12-03 192,100 192,100
    262 0104R0051018V000343 2018-12-03 192,100 192,100
    263 0104R0051018V000344 2018-12-03 192,100 192,100
    264 0104R0051018V000345 2018-12-03 192,100 192,100
    265 0104R0051018V000346 2018-12-03 192,100 192,100
    266 0104R0051018V000353 2018-12-03 167,000 167,000
    267 0104R0051018V000356 2018-12-03 192,100 192,100
    268 0104R0051018V000358 2018-12-03 192,100 192,100
    269 0104R0051018V000363 2018-12-03 193,500 193,500
    270 0104R0051018V000364 2018-12-03 192,100 192,100
    Hal.9/18

    UMPAN BALIK HASIL VERIFIKASI

    Nama RS : RUMAH SAKIT BUNDA - KAB. WAY KANAN


    Tingkat Pelayanan : RJTL
    Bulan Pelayanan : Oktober 2018

    271 0104R0051018V000365 2018-12-03 192,100 192,100


    272 0104R0051018V000366 2018-12-03 192,100 192,100
    273 0104R0051018V000367 2018-12-03 194,900 194,900
    274 0104R0051018V000368 2018-12-03 314,100 314,100
    275 0104R0051018V000369 2018-12-03 314,100 314,100
    276 0104R0051018V000370 2018-12-03 194,900 194,900
    277 0104R0051018V000373 2018-12-03 194,900 194,900
    278 0104R0051018V000374 2018-12-03 194,900 194,900
    279 0104R0051018V000375 2018-12-03 194,900 194,900
    280 0104R0051018V000376 2018-12-03 194,900 194,900
    281 0104R0051018V000379 2018-12-03 194,900 194,900
    282 0104R0051018V000380 2018-12-03 192,100 192,100
    283 0104R0051018V000382 2018-12-03 192,100 192,100
    284 0104R0051018V000383 2018-12-03 192,100 192,100
    285 0104R0051018V000384 2018-12-03 192,100 192,100
    286 0104R0051018V000386 2018-12-03 192,100 192,100
    287 0104R0051018V000389 2018-12-03 192,100 192,100
    288 0104R0051018V000390 2018-12-03 192,100 192,100
    289 0104R0051018V000392 2018-12-03 277,600 277,600
    290 0104R0051018V000393 2018-12-03 194,900 194,900
    291 0104R0051018V000394 2018-12-03 193,500 193,500
    292 0104R0051018V000395 2018-12-03 192,100 192,100
    293 0104R0051018V000396 2018-12-03 314,100 314,100
    294 0104R0051018V000398 2018-12-03 194,900 194,900
    295 0104R0051018V000399 2018-12-03 192,100 192,100
    296 0104R0051018V000400 2018-12-03 192,100 192,100
    297 0104R0051018V000401 2018-12-03 192,100 192,100
    298 0104R0051018V000402 2018-12-03 192,100 192,100
    299 0104R0051018V000403 2018-12-03 192,100 192,100
    300 0104R0051018V000404 2018-12-03 192,100 192,100
    301 0104R0051018V000405 2018-12-03 192,100 192,100
    302 0104R0051018V000406 2018-12-03 192,100 192,100
    303 0104R0051018V000407 2018-12-03 192,100 192,100
    304 0104R0051018V000408 2018-12-03 192,100 192,100
    Hal.10/18

    UMPAN BALIK HASIL VERIFIKASI

    Nama RS : RUMAH SAKIT BUNDA - KAB. WAY KANAN


    Tingkat Pelayanan : RJTL
    Bulan Pelayanan : Oktober 2018

    305 0104R0051018V000412 2018-12-03 192,100 192,100


    306 0104R0051018V000413 2018-12-03 192,100 192,100
    307 0104R0051018V000414 2018-12-03 192,100 192,100
    308 0104R0051018V000415 2018-12-03 192,100 192,100
    309 0104R0051018V000416 2018-12-03 192,100 192,100
    310 0104R0051018V000417 2018-12-03 192,100 192,100
    311 0104R0051018V000418 2018-12-03 192,100 192,100
    312 0104R0051018V000419 2018-12-03 192,100 192,100
    313 0104R0051018V000420 2018-12-03 192,100 192,100
    314 0104R0051018V000421 2018-12-03 192,100 192,100
    315 0104R0051018V000422 2018-12-03 192,100 192,100
    316 0104R0051018V000423 2018-12-03 192,100 192,100
    317 0104R0051018V000424 2018-12-03 192,100 192,100
    318 0104R0051018V000425 2018-12-03 192,100 192,100
    319 0104R0051018V000426 2018-12-03 192,100 192,100
    320 0104R0051018V000427 2018-12-03 192,100 192,100
    321 0104R0051018V000428 2018-12-03 192,100 192,100
    322 0104R0051018V000429 2018-12-03 192,100 192,100
    323 0104R0051018V000430 2018-12-03 192,100 192,100
    324 0104R0051018V000431 2018-12-03 192,100 192,100
    325 0104R0051018V000432 2018-12-03 192,100 192,100
    326 0104R0051018V000433 2018-12-03 192,100 192,100
    327 0104R0051018V000434 2018-12-03 192,100 192,100
    328 0104R0051018V000435 2018-12-03 192,100 192,100
    329 0104R0051018V000436 2018-12-03 192,100 192,100
    330 0104R0051018V000437 2018-12-03 192,100 192,100
    331 0104R0051018V000438 2018-12-03 192,100 192,100
    332 0104R0051018V000439 2018-12-03 192,100 192,100
    333 0104R0051018V000440 2018-12-03 192,100 192,100
    334 0104R0051018V000441 2018-12-03 192,100 192,100
    335 0104R0051018V000442 2018-12-03 192,100 192,100
    336 0104R0051018V000443 2018-12-03 192,100 192,100
    337 0104R0051018V000444 2018-12-03 192,100 192,100
    338 0104R0051018V000445 2018-12-03 192,100 192,100
    Hal.11/18

    UMPAN BALIK HASIL VERIFIKASI

    Nama RS : RUMAH SAKIT BUNDA - KAB. WAY KANAN


    Tingkat Pelayanan : RJTL
    Bulan Pelayanan : Oktober 2018

    339 0104R0051018V000446 2018-12-03 192,100 192,100


    340 0104R0051018V000447 2018-12-03 192,100 192,100
    341 0104R0051018V000448 2018-12-03 192,100 192,100
    342 0104R0051018V000449 2018-12-03 192,100 192,100
    343 0104R0051018V000450 2018-12-03 192,100 192,100
    344 0104R0051018V000451 2018-12-03 192,100 192,100
    345 0104R0051018V000452 2018-12-03 192,100 192,100
    346 0104R0051018V000453 2018-12-03 192,100 192,100
    347 0104R0051018V000454 2018-12-03 192,100 192,100
    348 0104R0051018V000455 2018-12-03 192,100 192,100
    349 0104R0051018V000456 2018-12-03 192,100 192,100
    350 0104R0051018V000457 2018-12-03 192,100 192,100
    351 0104R0051018V000458 2018-12-03 192,100 192,100
    352 0104R0051018V000459 2018-12-03 192,100 192,100
    353 0104R0051018V000460 2018-12-03 192,100 192,100
    354 0104R0051018V000461 2018-12-03 192,100 192,100
    355 0104R0051018V000462 2018-12-03 192,100 192,100
    356 0104R0051018V000463 2018-12-03 192,100 192,100
    357 0104R0051018V000464 2018-12-03 192,100 192,100
    358 0104R0051018V000465 2018-12-03 192,100 192,100
    359 0104R0051018V000466 2018-12-03 192,100 192,100
    360 0104R0051018V000467 2018-12-03 192,100 192,100
    361 0104R0051018V000468 2018-12-03 192,100 192,100
    362 0104R0051018V000469 2018-12-03 192,100 192,100
    363 0104R0051018V000470 2018-12-03 192,100 192,100
    364 0104R0051018V000471 2018-12-03 193,500 193,500
    365 0104R0051018V000472 2018-12-03 192,100 192,100
    366 0104R0051018V000473 2018-12-03 192,100 192,100
    367 0104R0051018V000474 2018-12-03 192,100 192,100
    368 0104R0051018V000475 2018-12-03 192,100 192,100
    369 0104R0051018V000476 2018-12-03 192,100 192,100
    370 0104R0051018V000477 2018-12-03 192,100 192,100
    371 0104R0051018V000478 2018-12-03 192,100 192,100
    372 0104R0051018V000479 2018-12-03 192,100 192,100
    Hal.12/18

    UMPAN BALIK HASIL VERIFIKASI

    Nama RS : RUMAH SAKIT BUNDA - KAB. WAY KANAN


    Tingkat Pelayanan : RJTL
    Bulan Pelayanan : Oktober 2018

    373 0104R0051018V000480 2018-12-03 194,900 194,900


    374 0104R0051018V000481 2018-12-03 192,100 192,100
    375 0104R0051018V000483 2018-12-03 314,100 314,100
    376 0104R0051018V000484 2018-12-03 192,100 192,100
    377 0104R0051018V000486 2018-12-03 192,100 192,100
    378 0104R0051018V000492 2018-12-03 192,100 192,100
    379 0104R0051018V000493 2018-12-03 192,100 192,100
    380 0104R0051018V000494 2018-12-03 192,100 192,100
    381 0104R0051018V000495 2018-12-03 192,100 192,100
    382 0104R0051018V000496 2018-12-03 192,100 192,100
    383 0104R0051018V000497 2018-12-03 192,100 192,100
    384 0104R0051018V000498 2018-12-03 192,100 192,100
    385 0104R0051018V000499 2018-12-03 192,100 192,100
    386 0104R0051018V000500 2018-12-03 192,100 192,100
    387 0104R0051018V000501 2018-12-03 192,100 192,100
    388 0104R0051018V000502 2018-12-03 192,100 192,100
    389 0104R0051018V000503 2018-12-03 192,100 192,100
    390 0104R0051018V000504 2018-12-03 192,100 192,100
    391 0104R0051018V000505 2018-12-03 192,100 192,100
    392 0104R0051018V000506 2018-12-03 314,100 314,100
    393 0104R0051018V000507 2018-12-03 314,100 314,100
    394 0104R0051018V000508 2018-12-03 314,100 314,100
    395 0104R0051018V000509 2018-12-03 192,100 192,100
    396 0104R0051018V000510 2018-12-03 192,100 192,100
    397 0104R0051018V000511 2018-12-03 192,100 192,100
    398 0104R0051018V000516 2018-12-03 314,100 314,100
    399 0104R0051018V000519 2018-12-03 192,100 192,100
    400 0104R0051018V000520 2018-12-03 192,100 192,100
    401 0104R0051018V000541 2018-12-03 192,100 192,100
    402 0104R0051018V000543 2018-12-03 194,900 194,900
    403 0104R0051018V000544 2018-12-03 192,100 192,100
    404 0104R0051018V000545 2018-12-03 192,100 192,100
    405 0104R0051018V000546 2018-12-03 314,100 314,100
    406 0104R0051018V000548 2018-12-03 192,100 192,100
    Hal.13/18

    UMPAN BALIK HASIL VERIFIKASI

    Nama RS : RUMAH SAKIT BUNDA - KAB. WAY KANAN


    Tingkat Pelayanan : RJTL
    Bulan Pelayanan : Oktober 2018

    407 0104R0051018V000549 2018-12-03 194,900 194,900


    408 0104R0051018V000550 2018-12-03 194,900 194,900
    409 0104R0051018V000552 2018-12-03 92,100 92,100
    410 0104R0051018V000561 2018-12-03 194,900 194,900
    411 0104R0051018V000563 2018-12-03 192,100 192,100
    412 0104R0051018V000564 2018-12-03 192,100 192,100
    413 0104R0051018V000565 2018-12-03 192,100 192,100
    414 0104R0051018V000566 2018-12-03 192,100 192,100
    415 0104R0051018V000567 2018-12-03 192,100 192,100
    416 0104R0051018V000568 2018-12-03 192,100 192,100
    417 0104R0051018V000569 2018-12-03 192,100 192,100
    418 0104R0051018V000570 2018-12-03 194,900 194,900
    419 0104R0051018V000571 2018-12-03 192,100 192,100
    420 0104R0051018V000572 2018-12-03 192,100 192,100
    421 0104R0051018V000575 2018-12-03 192,100 192,100
    422 0104R0051018V000579 2018-12-03 256,500 256,500
    423 0104R0051018V000580 2018-12-03 192,100 192,100
    424 0104R0051018V000581 2018-12-03 192,100 192,100
    425 0104R0051018V000582 2018-12-03 192,100 192,100
    426 0104R0051018V000583 2018-12-03 192,100 192,100
    427 0104R0051018V000584 2018-12-03 192,100 192,100
    428 0104R0051018V000585 2018-12-03 192,100 192,100
    429 0104R0051018V000586 2018-12-03 192,100 192,100
    430 0104R0051018V000587 2018-12-03 192,100 192,100
    431 0104R0051018V000588 2018-12-03 192,100 192,100
    432 0104R0051018V000589 2018-12-03 192,100 192,100
    433 0104R0051018V000590 2018-12-03 192,100 192,100
    434 0104R0051018V000592 2018-12-03 192,100 192,100
    435 0104R0051018V000593 2018-12-03 192,100 192,100
    436 0104R0051018V000594 2018-12-03 192,100 192,100
    437 0104R0051018V000595 2018-12-03 192,100 192,100
    438 0104R0051018V000596 2018-12-03 192,100 192,100
    439 0104R0051018V000597 2018-12-03 192,100 192,100
    440 0104R0051018V000598 2018-12-03 192,100 192,100
    Hal.14/18

    UMPAN BALIK HASIL VERIFIKASI

    Nama RS : RUMAH SAKIT BUNDA - KAB. WAY KANAN


    Tingkat Pelayanan : RJTL
    Bulan Pelayanan : Oktober 2018

    441 0104R0051018V000599 2018-12-03 192,100 192,100


    442 0104R0051018V000602 2018-12-03 192,100 192,100
    443 0104R0051018V000603 2018-12-03 192,100 192,100
    444 0104R0051018V000604 2018-12-03 192,100 192,100
    445 0104R0051018V000605 2018-12-03 192,100 192,100
    446 0104R0051018V000606 2018-12-03 192,100 192,100
    447 0104R0051018V000607 2018-12-03 192,100 192,100
    448 0104R0051018V000608 2018-12-03 192,100 192,100
    449 0104R0051018V000609 2018-12-03 193,500 193,500
    450 0104R0051018V000610 2018-12-03 192,100 192,100
    451 0104R0051018V000611 2018-12-03 192,100 192,100
    452 0104R0051018V000612 2018-12-03 192,100 192,100
    453 0104R0051018V000613 2018-12-03 192,100 192,100
    454 0104R0051018V000614 2018-12-03 192,100 192,100
    455 0104R0051018V000615 2018-12-03 192,100 192,100
    456 0104R0051018V000616 2018-12-03 192,100 192,100
    457 0104R0051018V000617 2018-12-03 192,100 192,100
    458 0104R0051018V000618 2018-12-03 192,100 192,100
    459 0104R0051018V000619 2018-12-03 192,100 192,100
    460 0104R0051018V000620 2018-12-03 192,100 192,100
    461 0104R0051018V000621 2018-12-03 192,100 192,100
    462 0104R0051018V000622 2018-12-03 192,100 192,100
    463 0104R0051018V000623 2018-12-03 192,100 192,100
    464 0104R0051018V000624 2018-12-03 192,100 192,100
    465 0104R0051018V000625 2018-12-03 192,100 192,100
    466 0104R0051018V000626 2018-12-03 192,100 192,100
    467 0104R0051018V000627 2018-12-03 192,100 192,100
    468 0104R0051018V000628 2018-12-03 192,100 192,100
    469 0104R0051018V000629 2018-12-03 192,100 192,100
    470 0104R0051018V000630 2018-12-03 192,100 192,100
    471 0104R0051018V000631 2018-12-03 192,100 192,100
    472 0104R0051018V000632 2018-12-03 192,100 192,100
    473 0104R0051018V000633 2018-12-03 192,100 192,100
    474 0104R0051018V000634 2018-12-03 192,100 192,100
    Hal.15/18

    UMPAN BALIK HASIL VERIFIKASI

    Nama RS : RUMAH SAKIT BUNDA - KAB. WAY KANAN


    Tingkat Pelayanan : RJTL
    Bulan Pelayanan : Oktober 2018

    475 0104R0051018V000635 2018-12-03 192,100 192,100


    476 0104R0051018V000636 2018-12-03 192,100 192,100
    477 0104R0051018V000637 2018-12-03 192,100 192,100
    478 0104R0051018V000639 2018-12-03 192,100 192,100
    479 0104R0051018V000640 2018-12-03 192,100 192,100
    480 0104R0051018V000642 2018-12-03 192,100 192,100
    481 0104R0051018V000643 2018-12-03 192,100 192,100
    482 0104R0051018V000644 2018-12-03 192,100 192,100
    483 0104R0051018V000645 2018-12-03 192,100 192,100
    484 0104R0051018V000646 2018-12-03 194,900 194,900
    485 0104R0051018V000647 2018-12-03 194,900 194,900
    486 0104R0051018V000648 2018-12-03 192,100 192,100
    487 0104R0051018V000649 2018-12-03 192,100 192,100
    488 0104R0051018V000650 2018-12-03 193,500 193,500
    489 0104R0051018V000651 2018-12-03 192,100 192,100
    490 0104R0051018V000652 2018-12-03 192,100 192,100
    491 0104R0051018V000653 2018-12-03 192,100 192,100
    492 0104R0051018V000654 2018-12-03 192,100 192,100
    493 0104R0051018V000656 2018-12-03 192,100 192,100
    494 0104R0051018V000661 2018-12-03 192,100 192,100
    495 0104R0051018V000662 2018-12-03 192,100 192,100
    496 0104R0051018V000666 2018-12-03 192,100 192,100
    497 0104R0051018V000667 2018-12-03 192,100 192,100
    498 0104R0051018V000668 2018-12-03 192,100 192,100
    499 0104R0051018V000672 2018-12-03 194,900 194,900
    500 0104R0051018V000674 2018-12-03 193,500 193,500
    501 0104R0051018V000678 2018-12-03 192,100 192,100
    502 0104R0051018V000680 2018-12-03 192,100 192,100
    503 0104R0051018V000681 2018-12-03 192,100 192,100
    504 0104R0051018V000682 2018-12-03 192,100 192,100
    505 0104R0051018V000685 2018-12-03 192,100 192,100
    506 0104R0051018V000686 2018-12-03 192,100 192,100
    507 0104R0051018V000687 2018-12-03 192,100 192,100
    508 0104R0051018V000688 2018-12-03 192,100 192,100
    Hal.16/18

    UMPAN BALIK HASIL VERIFIKASI

    Nama RS : RUMAH SAKIT BUNDA - KAB. WAY KANAN


    Tingkat Pelayanan : RJTL
    Bulan Pelayanan : Oktober 2018

    509 0104R0051018V000689 2018-12-03 192,100 192,100


    510 0104R0051018V000690 2018-12-03 194,900 194,900
    511 0104R0051018V000691 2018-12-03 192,100 192,100
    512 0104R0051018V000692 2018-12-03 192,100 192,100
    513 0104R0051018V000693 2018-12-03 194,900 194,900
    514 0104R0051018V000694 2018-12-03 192,100 192,100
    515 0104R0051018V000695 2018-12-03 192,100 192,100
    516 0104R0051018V000697 2018-12-03 192,100 192,100
    517 0104R0051018V000707 2018-12-03 192,100 192,100
    518 0104R0051018V000708 2018-12-03 192,100 192,100
    519 0104R0051018V000709 2018-12-03 192,100 192,100
    520 0104R0051018V000710 2018-12-03 192,100 192,100
    521 0104R0051018V000711 2018-12-03 192,100 192,100
    522 0104R0051018V000712 2018-12-03 192,100 192,100
    523 0104R0051018V000713 2018-12-03 192,100 192,100
    524 0104R0051018V000714 2018-12-03 192,100 192,100
    525 0104R0051018V000715 2018-12-03 192,100 192,100
    526 0104R0051018V000716 2018-12-03 192,100 192,100
    527 0104R0051018V000717 2018-12-03 192,100 192,100
    528 0104R0051018V000718 2018-12-03 192,100 192,100
    529 0104R0051018V000719 2018-12-03 192,100 192,100
    530 0104R0051018V000720 2018-12-03 192,100 192,100
    531 0104R0051018V000721 2018-12-03 192,100 192,100
    532 0104R0051018V000722 2018-12-03 192,100 192,100
    533 0104R0051018V000723 2018-12-03 192,100 192,100
    534 0104R0051018V000724 2018-12-03 192,100 192,100
    535 0104R0051018V000725 2018-12-03 192,100 192,100
    536 0104R0051018V000726 2018-12-03 192,100 192,100
    537 0104R0051018V000727 2018-12-03 192,100 192,100
    538 0104R0051018V000728 2018-12-03 192,100 192,100
    539 0104R0051018V000729 2018-12-03 192,100 192,100
    540 0104R0051018V000730 2018-12-03 192,100 192,100
    541 0104R0051018V000731 2018-12-03 192,100 192,100
    542 0104R0051018V000732 2018-12-03 192,100 192,100
    Hal.17/18

    UMPAN BALIK HASIL VERIFIKASI

    Nama RS : RUMAH SAKIT BUNDA - KAB. WAY KANAN


    Tingkat Pelayanan : RJTL
    Bulan Pelayanan : Oktober 2018

    543 0104R0051018V000733 2018-12-03 192,100 192,100


    544 0104R0051018V000737 2018-12-03 192,100 192,100
    545 0104R0051018V000738 2018-12-03 192,100 192,100
    546 0104R0051018V000739 2018-12-03 192,100 192,100
    547 0104R0051018V000740 2018-12-03 192,100 192,100
    548 0104R0051018V000741 2018-12-03 192,100 192,100
    549 0104R0051018V000743 2018-12-03 192,100 192,100
    550 0104R0051018V000744 2018-12-03 192,100 192,100
    551 0104R0051018V000745 2018-12-03 192,100 192,100
    552 0104R0051018V000746 2018-12-03 192,100 192,100
    553 0104R0051018V000748 2018-12-03 192,100 192,100
    554 0104R0051018V000749 2018-12-03 192,100 192,100
    555 0104R0051018V000750 2018-12-03 192,100 192,100
    556 0104R0051018V000751 2018-12-03 192,100 192,100
    557 0104R0051018V000752 2018-12-03 192,100 192,100
    558 0104R0051018V000754 2018-12-03 194,900 194,900
    559 0104R0051018V000755 2018-12-03 192,100 192,100
    560 0104R0051018V000757 2018-12-03 192,100 192,100
    561 0104R0051018V000758 2018-12-03 192,100 192,100
    562 0104R0051018V000759 2018-12-03 192,100 192,100
    563 0104R0051018V000760 2018-12-03 192,100 192,100
    564 0104R0051018V000761 2018-12-03 314,100 314,100
    565 0104R0051018V000762 2018-12-03 194,900 194,900
    566 0104R0051018V000765 2018-12-03 192,100 192,100
    567 0104R0051018V000771 2018-12-03 194,900 194,900
    568 0104R0051018V000774 2018-12-03 192,100 192,100
    569 0104R0051018V000778 2018-12-03 192,100 192,100
    570 0104R0051018V000780 2018-12-03 314,100 314,100
    571 0104R0051018V000784 2018-12-03 193,500 193,500
    572 0104R0051018V000786 2018-12-03 192,100 192,100
    573 0104R0051018V000787 2018-12-03 192,100 192,100
    574 0104R0051018V000788 2018-12-03 192,100 192,100
    575 0104R0051018V000789 2018-12-03 192,100 192,100
    576 0104R0051018V000790 2018-12-03 194,900 194,900
    Hal.18/18

    UMPAN BALIK HASIL VERIFIKASI

    Nama RS : RUMAH SAKIT BUNDA - KAB. WAY KANAN


    Tingkat Pelayanan : RJTL
    Bulan Pelayanan : Oktober 2018

    577 0104R0051018V000791 2018-12-03 192,100 192,100


    578 0104R0051018V000792 2018-12-03 192,100 192,100
    579 0104R0051018V000793 2018-12-03 194,900 194,900
    580 0104R0051018V000794 2018-12-03 256,500 256,500
    581 0104R0051018V000795 2018-12-03 192,100 192,100
    582 0104R0051018V000797 2018-12-03 192,100 192,100
    583 0104R0051018V000798 2018-12-03 192,100 192,100
    584 0104R0051018V000799 2018-12-03 192,100 192,100
    585 0104R0051018V000801 2018-12-03 192,100 192,100
    586 0104R0051018V000806 2018-12-03 192,100 192,100
    587 0104R0051018V000807 2018-12-03 192,100 192,100
    588 0104R0051018V000808 2018-12-03 306,600 306,600
    589 0104R0051018V000809 2018-12-03 192,100 192,100
    590 0104R0051018V000810 2018-12-03 192,100 192,100
    591 0104R0051018V000811 2018-12-03 192,100 192,100
    592 0104R0051018V000812 2018-12-03 192,100 192,100
    593 0104R0051018V000813 2018-12-03 192,100 192,100
    594 0104R0051018V000814 2018-12-03 192,100 192,100
    595 0104R0051018V000815 2018-12-03 192,100 192,100
    596 0104R0051018V000816 2018-12-03 192,100 192,100
    TOTAL 117,914,700 117,914,700

    RESUME
    Total Bea.Diajukan : 117,914,700
    Total Bea.Disetujui : 117,914,700

    Menyetujui Mengetahui
    Direktur RS BPJS KESEHATAN

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