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  • Rekapan Rajal Mei 2021

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    Muhammad Alfatih
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    This document contains details from the verification of 100 patient cases from RS Mutiara Hospital in Sorong City, West Papua, Indonesia for the month of May 2021. It lists information such as the patient case number, date of verification, actual costs incurred by the hospital, costs submitted for reimbursement, and costs approved. Many of the actual costs incurred by the hospital were lower than the costs submitted and later approved for reimbursement.

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    rekapan rajal mei 2021

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    This document contains details from the verification of 100 patient cases from RS Mutiara Hospital in Sorong City, West Papua, Indonesia for the month of May 2021. It lists information such as the patient case number, date of verification, actual costs incurred by the hospital, costs submitted for reimbursement, and costs approved. Many of the actual costs incurred by the hospital were lower than the costs submitted and later approved for reimbursement.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as pdf or txt
    6 views12 pages

    Rekapan Rajal Mei 2021

    Uploaded by

    Muhammad Alfatih
    This document contains details from the verification of 100 patient cases from RS Mutiara Hospital in Sorong City, West Papua, Indonesia for the month of May 2021. It lists information such as the patient case number, date of verification, actual costs incurred by the hospital, costs submitted for reimbursement, and costs approved. Many of the actual costs incurred by the hospital were lower than the costs submitted and later approved for reimbursement.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as pdf or txt
    of 12

    Hal.

    1/12

    RINCIAN DATA HASIL VERIFIKASI

    Nama RS : RS MUTIARA - KOTA SORONG


    Tingkat Pelayanan : RJTL
    Bulan Pelayanan : Mei 2021

    No No.SEP Tgl. Verifikasi Biaya


    Riil RS Diajukan Disetujui
    1 0392R0090521V000004 2021-08-10 76,950 196,100 196,100
    2 0392R0090521V000005 2021-08-10 109,700 196,100 196,100
    3 0392R0090521V000006 2021-08-10 80,000 196,100 196,100
    4 0392R0090521V000007 2021-08-10 156,300 196,100 196,100
    5 0392R0090521V000008 2021-08-10 160,850 196,100 196,100
    6 0392R0090521V000009 2021-08-10 195,450 196,100 196,100
    7 0392R0090521V000010 2021-08-10 139,000 196,100 196,100
    8 0392R0090521V000011 2021-08-10 161,300 276,900 276,900
    9 0392R0090521V000012 2021-08-10 140,600 196,100 196,100
    10 0392R0090521V000013 2021-08-10 216,700 196,100 196,100
    11 0392R0090521V000015 2021-08-10 178,650 196,100 196,100
    12 0392R0090521V000016 2021-08-10 137,200 276,900 276,900
    13 0392R0090521V000017 2021-08-10 96,415 276,900 276,900
    14 0392R0090521V000018 2021-08-10 103,550 196,100 196,100
    15 0392R0090521V000019 2021-08-10 226,150 196,100 196,100
    16 0392R0090521V000020 2021-08-10 216,700 196,100 196,100
    17 0392R0090521V000021 2021-08-10 161,100 196,100 196,100
    18 0392R0090521V000022 2021-08-10 217,000 196,100 196,100
    19 0392R0090521V000023 2021-08-10 171,800 196,100 196,100
    20 0392R0090521V000025 2021-08-10 196,500 196,100 196,100
    21 0392R0090521V000027 2021-08-10 140,950 196,100 196,100
    22 0392R0090521V000028 2021-08-10 197,600 196,100 196,100
    23 0392R0090521V000029 2021-08-10 70,000 196,100 196,100
    24 0392R0090521V000030 2021-08-10 81,600 196,100 196,100
    25 0392R0090521V000031 2021-08-10 188,800 196,100 196,100
    26 0392R0090521V000038 2021-08-10 172,700 196,100 196,100
    27 0392R0090521V000039 2021-08-10 84,450 196,100 196,100
    28 0392R0090521V000040 2021-08-10 214,400 196,100 196,100
    29 0392R0090521V000041 2021-08-10 148,600 196,100 196,100
    30 0392R0090521V000042 2021-08-10 173,700 196,100 196,100
    31 0392R0090521V000048 2021-08-10 158,350 196,100 196,100
    32 0392R0090521V000049 2021-08-10 129,750 196,100 196,100
    Hal.2/12

    RINCIAN DATA HASIL VERIFIKASI

    Nama RS : RS MUTIARA - KOTA SORONG


    Tingkat Pelayanan : RJTL
    Bulan Pelayanan : Mei 2021

    33 0392R0090521V000050 2021-08-10 142,600 196,100 196,100


    34 0392R0090521V000051 2021-08-10 211,050 196,100 196,100
    35 0392R0090521V000052 2021-08-10 90,500 196,100 196,100
    36 0392R0090521V000053 2021-08-10 184,250 196,100 196,100
    37 0392R0090521V000054 2021-08-10 169,550 196,100 196,100
    38 0392R0090521V000055 2021-08-10 168,050 332,900 332,900
    39 0392R0090521V000056 2021-08-10 84,100 196,100 196,100
    40 0392R0090521V000057 2021-08-10 136,400 276,900 276,900
    41 0392R0090521V000059 2021-08-10 213,450 196,100 196,100
    42 0392R0090521V000060 2021-08-10 186,700 196,100 196,100
    43 0392R0090521V000061 2021-08-10 155,000 196,100 196,100
    44 0392R0090521V000062 2021-08-10 185,200 196,100 196,100
    45 0392R0090521V000065 2021-08-10 159,200 255,800 255,800
    46 0392R0090521V000067 2021-08-10 96,800 196,100 196,100
    47 0392R0090521V000068 2021-08-10 141,600 196,100 196,100
    48 0392R0090521V000069 2021-08-10 82,650 193,000 193,000
    49 0392R0090521V000070 2021-08-10 82,150 196,100 196,100
    50 0392R0090521V000071 2021-08-10 74,700 196,100 196,100
    51 0392R0090521V000072 2021-08-10 67,650 130,300 130,300
    52 0392R0090521V000073 2021-08-10 110,900 193,000 193,000
    53 0392R0090521V000074 2021-08-10 92,350 193,000 193,000
    54 0392R0090521V000075 2021-08-10 65,000 196,100 196,100
    55 0392R0090521V000078 2021-08-10 65,000 196,100 196,100
    56 0392R0090521V000079 2021-08-10 193,000 196,100 196,100
    57 0392R0090521V000080 2021-08-10 221,950 196,100 196,100
    58 0392R0090521V000081 2021-08-10 125,000 196,100 196,100
    59 0392R0090521V000082 2021-08-10 202,850 196,100 196,100
    60 0392R0090521V000083 2021-08-10 122,325 196,100 196,100
    61 0392R0090521V000084 2021-08-10 230,300 196,100 196,100
    62 0392R0090521V000085 2021-08-10 100,300 196,100 196,100
    63 0392R0090521V000086 2021-08-10 91,850 196,100 196,100
    64 0392R0090521V000089 2021-08-10 200,550 196,100 196,100
    65 0392R0090521V000090 2021-08-10 143,350 196,100 196,100
    66 0392R0090521V000091 2021-08-10 228,550 196,100 196,100
    Hal.3/12

    RINCIAN DATA HASIL VERIFIKASI

    Nama RS : RS MUTIARA - KOTA SORONG


    Tingkat Pelayanan : RJTL
    Bulan Pelayanan : Mei 2021

    67 0392R0090521V000092 2021-08-10 385,505 196,100 196,100


    68 0392R0090521V000093 2021-08-10 79,825 196,100 196,100
    69 0392R0090521V000094 2021-08-10 247,700 196,100 196,100
    70 0392R0090521V000095 2021-08-10 50,000 255,800 255,800
    71 0392R0090521V000096 2021-08-10 90,700 193,000 193,000
    72 0392R0090521V000097 2021-08-10 202,050 196,100 196,100
    73 0392R0090521V000098 2021-08-10 67,650 196,100 196,100
    74 0392R0090521V000100 2021-08-10 137,150 196,100 196,100
    75 0392R0090521V000102 2021-08-10 62,700 193,000 193,000
    76 0392R0090521V000103 2021-08-10 81,400 193,000 193,000
    77 0392R0090521V000104 2021-08-10 62,000 255,800 255,800
    78 0392R0090521V000105 2021-08-10 138,950 255,800 255,800
    79 0392R0090521V000106 2021-08-10 202,500 196,100 196,100
    80 0392R0090521V000108 2021-08-10 70,825 193,000 193,000
    81 0392R0090521V000109 2021-08-10 46,150 255,800 255,800
    82 0392R0090521V000110 2021-08-10 106,850 196,100 196,100
    83 0392R0090521V000111 2021-08-10 84,800 196,100 196,100
    84 0392R0090521V000112 2021-08-10 65,000 196,100 196,100
    85 0392R0090521V000113 2021-08-10 211,250 276,900 276,900
    86 0392R0090521V000118 2021-08-10 65,000 130,300 130,300
    87 0392R0090521V000119 2021-08-10 82,650 196,100 196,100
    88 0392R0090521V000120 2021-08-10 50,000 326,000 326,000
    89 0392R0090521V000123 2021-08-10 80,350 193,000 193,000
    90 0392R0090521V000124 2021-08-10 92,150 255,800 255,800
    91 0392R0090521V000125 2021-08-10 166,100 196,100 196,100
    92 0392R0090521V000126 2021-08-10 174,900 196,100 196,100
    93 0392R0090521V000127 2021-08-10 84,800 196,100 196,100
    94 0392R0090521V000136 2021-08-10 100,600 196,100 196,100
    95 0392R0090521V000137 2021-08-10 205,350 196,100 196,100
    96 0392R0090521V000138 2021-08-10 246,300 196,100 196,100
    97 0392R0090521V000139 2021-08-10 177,400 196,100 196,100
    98 0392R0090521V000140 2021-08-10 125,600 196,100 196,100
    99 0392R0090521V000141 2021-08-10 117,400 196,100 196,100
    100 0392R0090521V000142 2021-08-10 216,800 196,100 196,100
    Hal.4/12

    RINCIAN DATA HASIL VERIFIKASI

    Nama RS : RS MUTIARA - KOTA SORONG


    Tingkat Pelayanan : RJTL
    Bulan Pelayanan : Mei 2021

    101 0392R0090521V000143 2021-08-10 77,350 196,100 196,100


    102 0392R0090521V000144 2021-08-10 221,200 276,900 276,900
    103 0392R0090521V000145 2021-08-10 171,800 196,100 196,100
    104 0392R0090521V000146 2021-08-10 137,850 196,100 196,100
    105 0392R0090521V000147 2021-08-10 198,900 196,100 196,100
    106 0392R0090521V000148 2021-08-10 116,400 196,100 196,100
    107 0392R0090521V000149 2021-08-10 65,000 196,100 196,100
    108 0392R0090521V000170 2021-08-10 146,250 196,100 196,100
    109 0392R0090521V000171 2021-08-10 270,000 565,600 565,600
    110 0392R0090521V000172 2021-08-10 317,300 196,100 196,100
    111 0392R0090521V000175 2021-08-10 81,250 196,100 196,100
    112 0392R0090521V000176 2021-08-10 135,050 196,100 196,100
    113 0392R0090521V000177 2021-08-10 152,900 196,100 196,100
    114 0392R0090521V000178 2021-08-10 163,500 196,100 196,100
    115 0392R0090521V000179 2021-08-10 319,300 565,600 565,600
    116 0392R0090521V000180 2021-08-10 136,100 196,100 196,100
    117 0392R0090521V000181 2021-08-10 218,850 196,100 196,100
    118 0392R0090521V000182 2021-08-10 187,000 196,100 196,100
    119 0392R0090521V000183 2021-08-10 108,500 196,100 196,100
    120 0392R0090521V000184 2021-08-10 279,100 196,100 196,100
    121 0392R0090521V000185 2021-08-10 169,000 196,100 196,100
    122 0392R0090521V000186 2021-08-10 137,150 196,100 196,100
    123 0392R0090521V000187 2021-08-10 118,100 255,800 255,800
    124 0392R0090521V000189 2021-08-10 148,650 196,100 196,100
    125 0392R0090521V000190 2021-08-10 210,625 196,100 196,100
    126 0392R0090521V000191 2021-08-10 136,950 196,100 196,100
    127 0392R0090521V000192 2021-08-10 108,800 196,100 196,100
    128 0392R0090521V000193 2021-08-10 65,000 196,100 196,100
    129 0392R0090521V000194 2021-08-10 160,100 196,100 196,100
    130 0392R0090521V000195 2021-08-10 264,300 196,100 196,100
    131 0392R0090521V000196 2021-08-10 164,000 196,100 196,100
    132 0392R0090521V000197 2021-08-10 140,950 196,100 196,100
    133 0392R0090521V000198 2021-08-10 140,200 196,100 196,100
    134 0392R0090521V000199 2021-08-10 175,750 196,100 196,100
    Hal.5/12

    RINCIAN DATA HASIL VERIFIKASI

    Nama RS : RS MUTIARA - KOTA SORONG


    Tingkat Pelayanan : RJTL
    Bulan Pelayanan : Mei 2021

    135 0392R0090521V000201 2021-08-10 99,050 196,100 196,100


    136 0392R0090521V000202 2021-08-10 135,950 196,100 196,100
    137 0392R0090521V000207 2021-08-10 133,550 196,100 196,100
    138 0392R0090521V000208 2021-08-10 182,050 196,100 196,100
    139 0392R0090521V000209 2021-08-10 200,050 196,100 196,100
    140 0392R0090521V000210 2021-08-10 91,800 196,100 196,100
    141 0392R0090521V000211 2021-08-10 143,650 196,100 196,100
    142 0392R0090521V000213 2021-08-10 253,200 196,100 196,100
    143 0392R0090521V000214 2021-08-10 200,350 196,100 196,100
    144 0392R0090521V000215 2021-08-10 225,550 196,100 196,100
    145 0392R0090521V000216 2021-08-10 328,800 196,100 196,100
    146 0392R0090521V000217 2021-08-10 247,650 196,100 196,100
    147 0392R0090521V000218 2021-08-10 208,600 196,100 196,100
    148 0392R0090521V000219 2021-08-10 103,900 196,100 196,100
    149 0392R0090521V000220 2021-08-10 225,100 196,100 196,100
    150 0392R0090521V000221 2021-08-10 230,100 196,100 196,100
    151 0392R0090521V000222 2021-08-10 116,100 196,100 196,100
    152 0392R0090521V000224 2021-08-10 145,825 196,100 196,100
    153 0392R0090521V000225 2021-08-10 121,800 196,100 196,100
    154 0392R0090521V000226 2021-08-10 132,850 196,100 196,100
    155 0392R0090521V000227 2021-08-10 102,000 196,100 196,100
    156 0392R0090521V000228 2021-08-10 217,150 196,100 196,100
    157 0392R0090521V000229 2021-08-10 266,200 196,100 196,100
    158 0392R0090521V000230 2021-08-10 104,350 196,100 196,100
    159 0392R0090521V000232 2021-08-10 235,500 196,100 196,100
    160 0392R0090521V000233 2021-08-10 273,300 196,100 196,100
    161 0392R0090521V000234 2021-08-10 341,000 565,600 565,600
    162 0392R0090521V000235 2021-08-10 196,500 196,100 196,100
    163 0392R0090521V000236 2021-08-10 92,900 196,100 196,100
    164 0392R0090521V000237 2021-08-10 326,900 196,100 196,100
    165 0392R0090521V000238 2021-08-10 101,650 196,100 196,100
    166 0392R0090521V000239 2021-08-10 119,850 196,100 196,100
    167 0392R0090521V000240 2021-08-10 192,625 196,100 196,100
    168 0392R0090521V000241 2021-08-10 98,600 196,100 196,100
    Hal.6/12

    RINCIAN DATA HASIL VERIFIKASI

    Nama RS : RS MUTIARA - KOTA SORONG


    Tingkat Pelayanan : RJTL
    Bulan Pelayanan : Mei 2021

    169 0392R0090521V000242 2021-08-10 115,850 196,100 196,100


    170 0392R0090521V000244 2021-08-10 139,600 196,100 196,100
    171 0392R0090521V000245 2021-08-10 139,400 196,100 196,100
    172 0392R0090521V000246 2021-08-10 120,500 196,100 196,100
    173 0392R0090521V000247 2021-08-10 160,450 196,100 196,100
    174 0392R0090521V000248 2021-08-10 178,400 196,100 196,100
    175 0392R0090521V000249 2021-08-10 273,200 196,100 196,100
    176 0392R0090521V000250 2021-08-10 158,400 196,100 196,100
    177 0392R0090521V000252 2021-08-10 141,450 196,100 196,100
    178 0392R0090521V000253 2021-08-10 198,625 196,100 196,100
    179 0392R0090521V000254 2021-08-10 416,050 196,100 196,100
    180 0392R0090521V000255 2021-08-10 164,700 196,100 196,100
    181 0392R0090521V000256 2021-08-10 207,250 196,100 196,100
    182 0392R0090521V000257 2021-08-10 161,350 196,100 196,100
    183 0392R0090521V000258 2021-08-10 174,625 196,100 196,100
    184 0392R0090521V000260 2021-08-10 206,325 196,100 196,100
    185 0392R0090521V000261 2021-08-10 252,050 196,100 196,100
    186 0392R0090521V000265 2021-08-10 60,600 255,800 255,800
    187 0392R0090521V000267 2021-08-10 254,750 196,100 196,100
    188 0392R0090521V000268 2021-08-10 160,700 196,100 196,100
    189 0392R0090521V000269 2021-08-10 260,450 196,100 196,100
    190 0392R0090521V000270 2021-08-10 107,900 196,100 196,100
    191 0392R0090521V000271 2021-08-10 162,950 196,100 196,100
    192 0392R0090521V000272 2021-08-10 110,550 196,100 196,100
    193 0392R0090521V000273 2021-08-10 142,650 196,100 196,100
    194 0392R0090521V000274 2021-08-10 101,350 196,100 196,100
    195 0392R0090521V000275 2021-08-10 170,900 196,100 196,100
    196 0392R0090521V000276 2021-08-10 149,700 196,100 196,100
    197 0392R0090521V000277 2021-08-10 162,500 196,100 196,100
    198 0392R0090521V000278 2021-08-10 282,400 565,600 565,600
    199 0392R0090521V000282 2021-08-10 213,450 196,100 196,100
    200 0392R0090521V000283 2021-08-10 237,400 196,100 196,100
    201 0392R0090521V000284 2021-08-10 114,400 196,100 196,100
    202 0392R0090521V000286 2021-08-10 249,800 196,100 196,100
    Hal.7/12

    RINCIAN DATA HASIL VERIFIKASI

    Nama RS : RS MUTIARA - KOTA SORONG


    Tingkat Pelayanan : RJTL
    Bulan Pelayanan : Mei 2021

    203 0392R0090521V000287 2021-08-10 182,750 196,100 196,100


    204 0392R0090521V000288 2021-08-10 200,250 196,100 196,100
    205 0392R0090521V000289 2021-08-10 208,500 196,100 196,100
    206 0392R0090521V000290 2021-08-10 184,950 196,100 196,100
    207 0392R0090521V000291 2021-08-10 77,500 196,100 196,100
    208 0392R0090521V000300 2021-08-10 98,100 196,100 196,100
    209 0392R0090521V000301 2021-08-10 99,600 196,100 196,100
    210 0392R0090521V000302 2021-08-10 228,700 196,100 196,100
    211 0392R0090521V000303 2021-08-10 181,000 196,100 196,100
    212 0392R0090521V000304 2021-08-10 207,450 276,900 276,900
    213 0392R0090521V000305 2021-08-10 148,950 196,100 196,100
    214 0392R0090521V000306 2021-08-10 210,550 196,100 196,100
    215 0392R0090521V000307 2021-08-10 196,100 196,100 196,100
    216 0392R0090521V000308 2021-08-10 115,900 196,100 196,100
    217 0392R0090521V000309 2021-08-10 217,700 196,100 196,100
    218 0392R0090521V000310 2021-08-10 141,750 196,100 196,100
    219 0392R0090521V000311 2021-08-10 168,300 196,100 196,100
    220 0392R0090521V000312 2021-08-10 126,800 196,100 196,100
    221 0392R0090521V000313 2021-08-10 99,300 276,900 276,900
    222 0392R0090521V000314 2021-08-10 175,600 196,100 196,100
    223 0392R0090521V000315 2021-08-10 153,600 196,100 196,100
    224 0392R0090521V000316 2021-08-10 113,700 196,100 196,100
    225 0392R0090521V000317 2021-08-10 186,625 196,100 196,100
    226 0392R0090521V000318 2021-08-10 95,000 196,100 196,100
    227 0392R0090521V000319 2021-08-10 133,550 196,100 196,100
    228 0392R0090521V000320 2021-08-10 136,500 196,100 196,100
    229 0392R0090521V000321 2021-08-10 165,100 196,100 196,100
    230 0392R0090521V000322 2021-08-10 84,715 196,100 196,100
    231 0392R0090521V000324 2021-08-10 246,550 196,100 196,100
    232 0392R0090521V000325 2021-08-10 128,900 196,100 196,100
    233 0392R0090521V000326 2021-08-10 94,300 196,100 196,100
    234 0392R0090521V000330 2021-08-10 177,650 196,100 196,100
    235 0392R0090521V000331 2021-08-10 110,200 196,100 196,100
    236 0392R0090521V000332 2021-08-10 236,000 196,100 196,100
    Hal.8/12

    RINCIAN DATA HASIL VERIFIKASI

    Nama RS : RS MUTIARA - KOTA SORONG


    Tingkat Pelayanan : RJTL
    Bulan Pelayanan : Mei 2021

    237 0392R0090521V000333 2021-08-10 203,150 196,100 196,100


    238 0392R0090521V000334 2021-08-10 200,700 196,100 196,100
    239 0392R0090521V000335 2021-08-10 131,350 196,100 196,100
    240 0392R0090521V000336 2021-08-10 182,950 196,100 196,100
    241 0392R0090521V000337 2021-08-10 181,000 196,100 196,100
    242 0392R0090521V000338 2021-08-10 164,350 276,900 276,900
    243 0392R0090521V000339 2021-08-10 88,500 196,100 196,100
    244 0392R0090521V000340 2021-08-10 96,050 196,100 196,100
    245 0392R0090521V000341 2021-08-10 133,200 196,100 196,100
    246 0392R0090521V000342 2021-08-10 128,750 196,100 196,100
    247 0392R0090521V000343 2021-08-10 121,350 196,100 196,100
    248 0392R0090521V000344 2021-08-10 198,900 196,100 196,100
    249 0392R0090521V000345 2021-08-10 215,500 196,100 196,100
    250 0392R0090521V000346 2021-08-10 215,200 196,100 196,100
    251 0392R0090521V000347 2021-08-10 144,850 196,100 196,100
    252 0392R0090521V000348 2021-08-10 96,050 196,100 196,100
    253 0392R0090521V000349 2021-08-10 119,400 196,100 196,100
    254 0392R0090521V000350 2021-08-10 151,750 196,100 196,100
    255 0392R0090521V000351 2021-08-10 123,150 196,100 196,100
    256 0392R0090521V000352 2021-08-10 147,600 196,100 196,100
    257 0392R0090521V000353 2021-08-10 261,100 196,100 196,100
    258 0392R0090521V000354 2021-08-10 131,800 196,100 196,100
    259 0392R0090521V000355 2021-08-10 316,800 565,600 565,600
    260 0392R0090521V000356 2021-08-10 150,200 196,100 196,100
    261 0392R0090521V000357 2021-08-10 84,250 130,300 130,300
    262 0392R0090521V000358 2021-08-10 204,000 196,100 196,100
    263 0392R0090521V000359 2021-08-10 122,700 196,100 196,100
    264 0392R0090521V000361 2021-08-10 125,800 196,100 196,100
    265 0392R0090521V000363 2021-08-10 144,000 196,100 196,100
    266 0392R0090521V000364 2021-08-10 244,850 196,100 196,100
    267 0392R0090521V000365 2021-08-10 218,450 196,100 196,100
    268 0392R0090521V000368 2021-08-10 172,200 196,100 196,100
    269 0392R0090521V000369 2021-08-10 104,200 196,100 196,100
    270 0392R0090521V000370 2021-08-10 178,850 196,100 196,100
    Hal.9/12

    RINCIAN DATA HASIL VERIFIKASI

    Nama RS : RS MUTIARA - KOTA SORONG


    Tingkat Pelayanan : RJTL
    Bulan Pelayanan : Mei 2021

    271 0392R0090521V000371 2021-08-10 84,800 196,100 196,100


    272 0392R0090521V000372 2021-08-10 124,400 196,100 196,100
    273 0392R0090521V000373 2021-08-10 192,700 196,100 196,100
    274 0392R0090521V000374 2021-08-10 175,900 196,100 196,100
    275 0392R0090521V000375 2021-08-10 190,950 196,100 196,100
    276 0392R0090521V000376 2021-08-10 147,100 196,100 196,100
    277 0392R0090521V000377 2021-08-10 149,650 196,100 196,100
    278 0392R0090521V000378 2021-08-10 91,200 196,100 196,100
    279 0392R0090521V000379 2021-08-10 101,800 196,100 196,100
    280 0392R0090521V000380 2021-08-10 185,200 196,100 196,100
    281 0392R0090521V000381 2021-08-10 295,200 196,100 196,100
    282 0392R0090521V000382 2021-08-10 153,900 196,100 196,100
    283 0392R0090521V000383 2021-08-10 153,450 196,100 196,100
    284 0392R0090521V000384 2021-08-10 142,400 196,100 196,100
    285 0392R0090521V000385 2021-08-10 169,200 196,100 196,100
    286 0392R0090521V000386 2021-08-10 185,350 196,100 196,100
    287 0392R0090521V000387 2021-08-10 175,700 196,100 196,100
    288 0392R0090521V000388 2021-08-10 180,150 196,100 196,100
    289 0392R0090521V000389 2021-08-10 159,400 196,100 196,100
    290 0392R0090521V000390 2021-08-10 177,650 276,900 276,900
    291 0392R0090521V000391 2021-08-10 145,550 196,100 196,100
    292 0392R0090521V000392 2021-08-10 132,300 196,100 196,100
    293 0392R0090521V000393 2021-08-10 179,850 196,100 196,100
    294 0392R0090521V000394 2021-08-10 138,700 196,100 196,100
    295 0392R0090521V000395 2021-08-10 141,650 196,100 196,100
    296 0392R0090521V000396 2021-08-10 248,000 565,600 565,600
    297 0392R0090521V000397 2021-08-10 156,800 196,100 196,100
    298 0392R0090521V000398 2021-08-10 138,800 196,100 196,100
    299 0392R0090521V000399 2021-08-10 431,500 196,100 196,100
    300 0392R0090521V000400 2021-08-10 107,000 196,100 196,100
    301 0392R0090521V000401 2021-08-10 340,200 196,100 196,100
    302 0392R0090521V000402 2021-08-10 170,700 196,100 196,100
    303 0392R0090521V000403 2021-08-10 172,300 196,100 196,100
    304 0392R0090521V000404 2021-08-10 102,400 196,100 196,100
    Hal.10/12

    RINCIAN DATA HASIL VERIFIKASI

    Nama RS : RS MUTIARA - KOTA SORONG


    Tingkat Pelayanan : RJTL
    Bulan Pelayanan : Mei 2021

    305 0392R0090521V000405 2021-08-10 251,150 196,100 196,100


    306 0392R0090521V000406 2021-08-10 130,350 196,100 196,100
    307 0392R0090521V000407 2021-08-10 192,950 196,100 196,100
    308 0392R0090521V000408 2021-08-10 231,050 196,100 196,100
    309 0392R0090521V000409 2021-08-10 253,750 196,100 196,100
    310 0392R0090521V000410 2021-08-10 214,200 196,100 196,100
    311 0392R0090521V000411 2021-08-10 180,800 196,100 196,100
    312 0392R0090521V000413 2021-08-10 285,800 565,600 565,600
    313 0392R0090521V000415 2021-08-10 113,550 196,100 196,100
    314 0392R0090521V000417 2021-08-10 102,850 196,100 196,100
    315 0392R0090521V000418 2021-08-10 105,950 196,100 196,100
    316 0392R0090521V000419 2021-08-10 350,350 196,100 196,100
    317 0392R0090521V000420 2021-08-10 119,850 196,100 196,100
    318 0392R0090521V000421 2021-08-10 193,000 196,100 196,100
    319 0392R0090521V000422 2021-08-10 151,850 196,100 196,100
    320 0392R0090521V000423 2021-08-10 254,700 196,100 196,100
    321 0392R0090521V000424 2021-08-10 189,400 196,100 196,100
    322 0392R0090521V000425 2021-08-10 124,800 196,100 196,100
    323 0392R0090521V000426 2021-08-10 231,800 196,100 196,100
    324 0392R0090521V000427 2021-08-10 173,700 196,100 196,100
    325 0392R0090521V000428 2021-08-10 154,950 196,100 196,100
    326 0392R0090521V000429 2021-08-10 97,050 196,100 196,100
    327 0392R0090521V000430 2021-08-10 104,200 196,100 196,100
    328 0392R0090521V000431 2021-08-10 234,850 196,100 196,100
    329 0392R0090521V000434 2021-08-10 213,050 196,100 196,100
    330 0392R0090521V000435 2021-08-10 82,650 196,100 196,100
    331 0392R0090521V000436 2021-08-10 261,250 565,600 565,600
    332 0392R0090521V000437 2021-08-10 87,750 196,100 196,100
    333 0392R0090521V000438 2021-08-10 157,550 196,100 196,100
    334 0392R0090521V000439 2021-08-10 140,300 196,100 196,100
    335 0392R0090521V000440 2021-08-10 123,950 196,100 196,100
    336 0392R0090521V000441 2021-08-10 198,650 196,100 196,100
    337 0392R0090521V000442 2021-08-10 126,900 196,100 196,100
    338 0392R0090521V000443 2021-08-10 108,850 196,100 196,100
    Hal.11/12

    RINCIAN DATA HASIL VERIFIKASI

    Nama RS : RS MUTIARA - KOTA SORONG


    Tingkat Pelayanan : RJTL
    Bulan Pelayanan : Mei 2021

    339 0392R0090521V000445 2021-08-10 101,000 196,100 196,100


    340 0392R0090521V000447 2021-08-10 130,000 196,100 196,100
    341 0392R0090521V000448 2021-08-10 105,250 196,100 196,100
    342 0392R0090521V000449 2021-08-10 73,850 139,700 139,700
    343 0392R0090521V000450 2021-08-10 115,550 196,100 196,100
    344 0392R0090521V000451 2021-08-10 85,000 196,100 196,100
    345 0392R0090521V000452 2021-08-10 123,300 196,100 196,100
    346 0392R0090521V000453 2021-08-10 127,650 196,100 196,100
    347 0392R0090521V000461 2021-08-10 50,000 255,800 255,800
    348 0392R0090521V000462 2021-08-10 50,000 193,000 193,000
    349 0392R0090521V000463 2021-08-10 111,400 196,100 196,100
    350 0392R0090521V000464 2021-08-10 96,800 193,000 193,000
    351 0392R0090521V000465 2021-08-10 59,550 255,800 255,800
    352 0392R0090521V000473 2021-08-10 158,400 196,100 196,100
    353 0392R0090521V000474 2021-08-10 108,400 196,100 196,100
    354 0392R0090521V000475 2021-08-10 77,350 196,100 196,100
    355 0392R0090521V000476 2021-08-10 158,200 255,800 255,800
    356 0392R0090521V000477 2021-08-10 96,150 276,900 276,900
    357 0392R0090521V000479 2021-08-10 191,900 196,100 196,100
    358 0392R0090521V000480 2021-08-10 153,250 196,100 196,100
    359 0392R0090521V000481 2021-08-10 135,600 196,100 196,100
    360 0392R0090521V000482 2021-08-10 167,100 196,100 196,100
    361 0392R0090521V000483 2021-08-10 111,200 276,900 276,900
    362 0392R0090521V000484 2021-08-10 286,150 196,100 196,100
    363 0392R0090521V000485 2021-08-10 90,700 196,100 196,100
    364 0392R0090521V000486 2021-08-10 97,825 276,900 276,900
    365 0392R0090521V000487 2021-08-10 185,425 196,100 196,100
    366 0392R0090521V000488 2021-08-10 160,850 196,100 196,100
    367 0392R0090521V000489 2021-08-10 250,000 332,900 332,900
    368 0392R0090521V000490 2021-08-10 250,000 332,900 332,900
    369 0392R0090521V000491 2021-08-10 250,000 332,900 332,900
    370 0392R0090521V000492 2021-08-10 250,000 196,100 196,100
    371 0392R0090521V000493 2021-08-10 250,000 332,900 332,900
    372 0392R0090521V000494 2021-08-10 105,400 196,100 196,100
    Hal.12/12

    RINCIAN DATA HASIL VERIFIKASI

    Nama RS : RS MUTIARA - KOTA SORONG


    Tingkat Pelayanan : RJTL
    Bulan Pelayanan : Mei 2021

    373 0392R0090521V000495 2021-08-10 250,000 332,900 332,900


    374 0392R0090521V000497 2021-08-10 250,000 196,100 196,100
    375 0392R0090521V000498 2021-08-10 78,250 255,800 255,800
    376 0392R0090521V000499 2021-08-10 159,250 196,100 196,100
    377 0392R0090521V000500 2021-08-10 20,000 130,300 130,300
    TOTAL 60,235,885 79,252,600 79,252,600

    RESUME
    Total Bea.Diajukan : 79,252,600
    Total Bea.Disetujui : 79,252,600

    Menyetujui Mengetahui
    Direktur RS BPJS KESEHATAN

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