LAPORAN KLAIM PROVIDER RSPP sd SEP

NO TANGGAL ANALISA PROVIDER PERIODE MANFAAT

1 1/25/2018 RSPP 01-03/01/18 RI

2 2/20/2018 RSPP 08-10/01/18 RJ
3 2/21/2018 RSPP 11-15/01/18 RJ
4 2/27/2018 RSPP 16-20/01/18 RJ
5 2/27/2018 RSPP 06-23/01/18 RI
6 2/27/2018 RSPP 22-26/01/18 RJ
7 9/27/2018 RSPP RJ
8 01-05/02/18 RSPP 01-05/02/18 RJ
9 3/12/2018 RSPP 07-09/02/18 RJ
10 3/13/2018 RSPP 12-15/02/18 RJ
11 3/20/2018 RSPP 19-20/02/18 RJ
12 3/23/2018 RSPP 21-27/02/18 RJ
13 3/23/2018 RSPP 01-05/03/18 RJ
14 3/29/2018 RSPP 07-09/03/18 RJ
15 4/9/2018 RSPP 13-15/03/18 RJ
16 4/17/2018 RSPP 16-20/03/18 RJ
17 4/24/2018 RSPP 21-29/03/18 RJ
18 5/22/2018 RSPP 16-31/03/18 RI
19 02/05/18 RSPP 03-05/04/18 RJ
20 07/05/18 RSPP 06-10/04/18 RJ
21 07/05/18 RSPP 11-16/04/18 RI
22 07/05/18 RSPP 11-15/04/18 RJ
23 21/05/18 RSPP 16-30/04/18 RJ
24 03/07/18 RSPP 16-30/04/18 RJ
25 06/06/18 RSPP 01-15/05/18 RJ
26 06/06/18 RSPP 01-05/05/18 RJ
27 03/07/18 RSPP 16-20/05/18 RJ
28 03/07/18 RSPP 11-15/05/18 RJ
29 03/07/18 RSPP 21-31/05/18 RJ
30 12/07/18 RS. Pertamina Cirebon 01-15/06/18 RJ
31 16/07/18 RSPP 16-30/06/18 RJ
32 18/07/18 RSPP 01-15/06/18 RI
33 RJ
34 18/07/18 RSPP 01-15/06/18 RT
35 18/07/18 RSPP 01-15/06/18 RJ
36 18/07/18 RSPP 16-30/06/18 RJ
37 19/07/18 RSPP 01-15/07/18 RI
38 24/07/18 RSPP 01-15/07/2018 RJ
39 30/07/18 RS PERTAMINA CIREBON 01-15/07/2018 RJ
40 03/08/18 RSPP 01-15/07/18 RJ
41 06/08/18 RSPP 01-15/07/18 RJ
42 14/08/18 RSPP 16-31/07/18 RJ
43 23/08/18 RSPP 16-31/07/18 RJ
44 23/08/18 RSPP 01-15/08/18 RT
45 10/09/18 RSPP 06-10/08/18 RJ
46 10/09/18 RSPP 11-15/08/18 RJ
47 18/09/18 RSPP 16-31/08/18 RJ
48 28/09/18 RSPP 01-15/09/18 RJ
N KLAIM PROVIDER RSPP sd SEPT 2018

BIAYA NILAI
PERAWATAN DITANGGUN DITANGGUN DIBAYAR BPL
NO. TAGIHAN DITOLAK BPDT (Rp)
G PESERTA (Rp)
(Rp) G JKN (Rp) (Rp)
(Rp)

148618/1801001 8,464,068 - 1,030,000 7,434,068 - -

148618/1801003 4,481,820 - - 4,481,820 - -
148618/1801004 19,562,522 - - 14,866,830 1,290,000 3,405,692
148618/1801005 1,871,253 - - 1,871,253 - -
148618/1801007 70,213,796 - 20,139,995 50,073,801 - -
148618/1801006 11,372,531 - - 10,819,961 552,570 -
148618/1801002 4,353,078 - - 2,704,078 1,649,000 -
148618/1802001 5,302,341 - - 4,432,340 870,001 -
148618/1802002 2,219,301 - - 1,979,301 240,000 -
148618/1802003 6,907,543 - - 6,547,543 360,000 -
148618/1802004 4,668,497 - - 4,548,497 120,000 -
148618/1802005 7,041,594 - - 2,321,804 120,000 4,599,790
148618/1803001 3,032,836 - - 3,002,431 30,405 -
148618/1803002 5,019,398 - 365,000 4,654,398 - -
148618/1803003 7,054,365 - - 6,787,365 267,000 -
148618/1803004 5,296,919 - - 5,253,553 43,366 -
148618/1803005 13,931,436 - - 12,304,436 1,627,000 -
148618/1805002 45,227,646 - - 43,105,646 2,122,000 -
148618/1804001 4,597,352 - - 4,210,352 387,000 -
148618/1804002 3,913,055 - - 3,793,055 120,000 -
148618/1804003 20,108,281 - - 19,948,281 160,000 -
148618/1804004 4,872,383 - - 4,605,383 267,000 -
148618/1804005 3,810,508 - - 3,423,508 387,000 -
148618/1804006 5,256,417 - - 4,910,528 345,889 -
148618/1805003 3,492,147 - - 3,287,876 204,271 -
148618/1805001 2,496,975 - - 2,496,975 - -
148618/1805005 4,334,132 - 467,477 3,866,655 - -
148618/1805004 3,191,270 - - 3,191,270 - -
148618/1805006 8,765,776 - - 7,353,776 1,412,000 -
N04DN18060140 610,860 - - 606,860 4,000 -
148618/1806005 2,943,463 - - 2,943,463 - -
148618/1806002 1,343,812 - - 1,343,812 - -
2,434,236 - - 1,996,236 438,000 -
148618/1806001 384,000 - - 200,000 184,000 -
148618/1806003 1,072,773 - - 1,072,773 - -
148618/1806004 1,063,734 - - 1,063,734 - -
148618/1807001 16,443,165 - 13,146,967 3,186,198 110,000 -
148618/1807002 1,134,646 - - 1,014,646 120,000 -
N04DN18070110 1,044,156 - - 1,022,432 21,724 -
148618/1807003 538,600 - - 538,600 - -
148618/1807004 1,509,595 - - 1,509,595 - -
148618/1807005 447,396 - - 447,396 - -
148618/1807006 3,952,182 - - 3,233,182 719,000 -
148618/1808001 1,611,000 - - 300,000 1,311,000 -
148618/1808002 10,635,893 - - 9,061,893 1,574,000 -
148618/1808003 5,027,769 - - 5,010,306 17,463 -
148618/1808004 7,532,224 - - 6,986,100 - 546,124
148618/1809001 2,831,678 - - 2,831,678 - -
353,420,422 292,645,688 17,073,689
4.8% Pembulatan