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  • BPJS Kesehatan Cab. TANGGERANG: Umpan Balik Verifikasi Pengajuan Klaim Tingkat Pertama

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    This document is a verification report from BPJS Kesehatan for a claim submission from PUSKESMAS TAJUR for April 2021. It details that 16 patients received treatment totaling Rp. 815,000, all of which were verified as eligible with no pending or disputed claims. All 16 claims for RJTP treatment ranging from Rp. 15,000 to Rp. 100,000 from April 5th to 29th were approved.

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    This document is a verification report from BPJS Kesehatan for a claim submission from PUSKESMAS TAJUR for April 2021. It details that 16 patients received treatment totaling Rp. 815,000, all of which were verified as eligible with no pending or disputed claims. All 16 claims for RJTP treatment ranging from Rp. 15,000 to Rp. 100,000 from April 5th to 29th were approved.

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    11 views1 page

    BPJS Kesehatan Cab. TANGGERANG: Umpan Balik Verifikasi Pengajuan Klaim Tingkat Pertama

    Uploaded by

    puskesmas tajur
    This document is a verification report from BPJS Kesehatan for a claim submission from PUSKESMAS TAJUR for April 2021. It details that 16 patients received treatment totaling Rp. 815,000, all of which were verified as eligible with no pending or disputed claims. All 16 claims for RJTP treatment ranging from Rp. 15,000 to Rp. 100,000 from April 5th to 29th were approved.

    Copyright:

    © All Rights Reserved
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    of 1

    BPJS Kesehatan Cab.

    TANGGERANG
    UMPAN BALIK VERIFIKASI
    PENGAJUAN KLAIM TINGKAT PERTAMA

    Nomor FPK : P2104000003854

    Provider : PUSKESMAS TAJUR

    Bulan Pelayanan : April 2021

    Pelayanan : RJTP

    Pelayanan Verifikasi

    Total Data : 16 Total Data : 16 Layak : 16 Tidak Layak : 0

    Total Tagihan : Rp. 815.000 Total Tagihan : Rp. 815.000 Pending : 0 DIspute : 0

    NO TRANSAKSI NAMA PESERTA TGL MASUK TGL PULANG BIAYA STAT KETERANGAN

    102503030421Y000087 HERMINA SIHOMBING (0001477006244) 05/04/2021 05/04/2021 Rp. 50.000 Layak

    102503030421Y000126 TRI MURTI MASRIK (0001484366938) 05/04/2021 05/04/2021 Rp. 50.000 Layak

    102503030421Y000230 ARMI (0002421260212) 08/04/2021 08/04/2021 Rp. 50.000 Layak

    KRIS MONICA DWI BUDIARTI


    102503030421Y000238 08/04/2021 08/04/2021 Rp. 50.000 Layak
    (0002102677312)
    RENNY SHYNTA TRINAWATI
    102503030421Y000245 08/04/2021 08/04/2021 Rp. 50.000 Layak
    (0001144508859)

    102503030421Y000256 YUNI IRANDA (0002925531549) 08/04/2021 08/04/2021 Rp. 50.000 Layak

    102503030421Y000258 NURLELAH (0001369961019) 08/04/2021 08/04/2021 Rp. 50.000 Layak

    102503030421Y000261 DIAN ESTY PUSPITA (0002075212539) 08/04/2021 08/04/2021 Rp. 50.000 Layak

    102503030421Y000262 ISTIKHANAH (0000455723987) 08/04/2021 08/04/2021 Rp. 50.000 Layak

    102503030421Y000263 HIFZILLAH ARMY (0002616982312) 08/04/2021 08/04/2021 Rp. 50.000 Layak

    102503030421Y000267 PUTRI APRIYANTI (0001662628678) 08/04/2021 08/04/2021 Rp. 50.000 Layak

    102503030421Y000277 AFTAZIAH FARIDA (0001611185016) 09/04/2021 09/04/2021 Rp. 15.000 Layak

    102503030421Y000552 SITI KHOFIFAH (0001480181106) 17/04/2021 17/04/2021 Rp. 100.000 Layak

    102503030421Y000698 RIZKI FITRIYANI (0000038030117) 22/04/2021 22/04/2021 Rp. 50.000 Layak

    102503030421Y000714 ANA MAHARIANA (0002518141533) 22/04/2021 22/04/2021 Rp. 50.000 Layak

    102503030421Y000923 NOVI YANTI (0000815470694) 29/04/2021 29/04/2021 Rp. 50.000 Layak

    Tanggal, 28/02/2022
    Tanggal terima FPK,
    Pengaju Klaim
    Verifikator

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