ASSIGCLAIMS ID DAY STATUS ICD DESCRIPTI CARD NO

NSOKT132721584 2 23 R56 Convulsions 8000210200

NSOKT132722729 2 23 R07.1 Chest pain o 8000210120
NSOKT132716383 2 23 R10 Abdominal an8000210119
NSOKT132719078 2 23 J18.0 BRONCHOPN 8000210117
NSOKT132718874 2 23 N83 Cyst Ovary ( 8000210118
LXMAY132718803 2 23 A90 DENGUE FE8000210120
LXMAY132719622 2 23 R50.9 Fever 8000210116
J_LXA 132718983 2 23 A91 Dengue Haem 8000210120
J_LXA 132722491 2 23 R50.9 Fever 8000210118
J_LXA 132719701 2 23 R50 Fever of Un 8000210120
J_LXA 132719054 2 23 A09 Diarrhoea and8000210118
J_LXA 132722723 2 23 A01.0 Typhoid Feve8000210116
LXMAY132722775 2 23 N20.1 CALCULUS 8000210200
IS_FH 132722758 2 23 R50.9 Fever 8000210121
IS_FH 132722939 2 23 R50.9 Fever 8000210121
IS_FH 132715530 2 23 R50.9 Fever 8000210121
IS_FH 132722392 2 23 R11 Nausea and V8000210119
NSOKT132718754 2 23 XXX Cancel Trans8000210119
NSOKT132720364 2 23 R50.9 Fever 8000210121
NSOKT132719718 2 23 R50 Fever of Un 8000210112
NSOKT132721365 2 23 K30 Dyspepsia 8000210116
XXUSRI132722623 2 23 A01 TYPHOID A 8000210200
NSOKT132722726 2 23 A01 TYPHOID A 8000210200
NSOKT132719770 2 23 M54.2 Cervicalgia 8000210115
IS_FH 132722882 2 23 I61 Intracerebra 8000210118
LXMAY132719663 2 23 N93 Other abnorm8000210118
LXMAY132716555 2 23 R10 Abdominal an8000210118
MXAGU 132722403 2 23 A09 Diarrhoea and8000210121
MXAGU 132714674 2 23 R50.9 Fever 8000210119
MXAGU 132722806 2 23 R50.9 Fever 8000210117
MXAGU 132719990 2 23 R50.9 Fever 8000210120
MXAGU 132720463 2 23 R50.9 Fever 8000210120
MXAGU 132722259 2 23 J06 Acute upper r8000210120
XXUSRI132719675 2 23 R50 Fever of Un 8000210200
XXUSRI132719807 2 23 R51 Headache ( 8000210119
XXUSRI132713503 2 23 A09 Diarrhoea and8000210200
XXUSRI132713704 2 23 R50 Fever of Un 8000210121
XXUSRI132714888 2 23 S09 OTHER AND8000210116
J_LXA 132715373 2 23 R50.9 Fever 8000210120
J_LXA 132718334 2 23 R50.9 Fever 8000210200
J_LXA 132715936 2 23 A09 Diarrhoea and8000210120
J_LXA 132715932 2 23 A09 Diarrhoea and8000210107
J_LXA 132712026 2 23 R50.9 Fever 8000210113
J_LXA 132714233 2 23 A90 DENGUE FE8000210118
MXAGU 132721886 2 23 R50 Fever of Un 8000210116
MXAGU 132722750 2 23 R00.0 Tachycardia, 8000210117
IS_FH 132722580 2 23 S09 OTHER AND8000210200
IS_FH 132714313 2 23 A91 Dengue Haem 8000210118
IS_FH 132714809 2 23 R50.9 Fever 8000210117
IS_FH 132719121 2 23 A49 Bacterial infe 8000210119
IS_FH 132719607 2 23 R50 Fever of Un 8000210200
IS_FH 132722404 2 23 R10 Abdominal an8000210111
LXMAY132716909 2 23 R50.9 Fever 8000210200
LXMAY132713970 2 23 J45 Asthma 8000210115
LXMAY132717089 2 23 R50.9 Fever 8000210116
MXAGU 132722638 2 23 A01 TYPHOID A 8000210200
MXAGU 132713500 2 23 R50.9 Fever 8000210121
MXAGU 132721733 2 23 A09 Diarrhoea and8000210121
LXMAY132720151 2 23 R50.9 Fever 8000210118
LXMAY132716051 2 23 R50.9 Fever 8000210200
LXMAY132718366 2 23 R50.9 Fever 8000210114
XXUSRI132720163 2 23 R50.9 Fever 8000210200
XXUSRI132719108 2 23 K35 Acute Appendi 8000210200
XXUSRI132717560 2 23 D64.9 ANAEMIA 8000210111
XXUSRI132714630 2 23 R50 Fever of Un 8000210119
XXUSRI132721385 2 23 R50.9 Fever 8000210116
132390782 11 23 C32 MALIGNANT8000210115
131480492 43 23 K83.1 Obstruction o8000210119

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PATIENT N PROVIDER COPRORATE
MUHAMMADRS. HERMINA PRODUCT HSCPP REVAMP - HSRPRV_IND
CHEN YANJRS. MITRA KE HOSPITAL & SURGICAL CARE PREMIER PLUS - HSRP_IND
MEIRIA NURRS. CIPUTRAHOSPITAL & SURGICAL CARE PREMIER PLUS - HSRP_IND
ADOLFINE RS. MITRA KE HS CARE PREMIER XTRA - HSCPX_IND
PUPUT HILDRS. PRIMA MED
HOSPITAL & SURGICAL CARE PREMIER PLUS - HSRP_IND
CANDICE K RS. CIPUTRAHS CARE PREMIER XTRA - HSCPX_IND
BUI TJIE RS. ROYAL TA
HS CARE PREMIER XTRA - HSCPX_IND
HANNA ORLE RS. CIPUTRAHOSPITAL & SURGICAL CARE PREMIER PLUS - HSRP_IND
YUKIRTOF SILOAM HOSPI HOSPITAL & SURGICAL CARE PREMIER PLUS - HSRP_IND
TWESTY G RS. PONDOKHOSPITAL
I & SURGICAL CARE PREMIER PLUS - HSRP_IND
DIANA MADERS. HERMINA HS CARE PREMIER XTRA - HSCPX_IND
KARYN RS. ROYAL TA
HS CARE PREMIER XTRA - HSCPX_IND
MUSZALIFA RS. MITRA KEPT WELL HARVEST WINNING ALUMINA REFINERY - ALI0005767
STEFANIE TZU CHI HOSPIHOSPITAL & SURGICAL CARE PREMIER PLUS - HSRP_IND
LISMAINI RS. EMC PULO
HOSPITAL & SURGICAL CARE PREMIER PLUS - HSRP_IND
LAMBERTUSRS. ST.VINCE HOSPITAL & SURGICAL CARE PREMIER PLUS - HSRP_IND
KINGJACOB RS. ADVENTHOSPITAL
M & SURGICAL CARE PREMIER PLUS - HSRP_IND
MARIA ANIT RS. TELOGORE
HOSPITAL & SURGICAL CARE PREMIER PLUS - HSRP_IND
OLIVIA SET BETHSAIDA HOSPITAL
HO & SURGICAL CARE PREMIER PLUS - HSRP_IND
MUHAMMADRS. HUSADAH&S U INDIVIDU - H&S_IND
CHINTIA J RS. STELLA HMS CARE PREMIER XTRA - HSCPX_IND
ADIFA HUM RS. JAKARTA REKAN USAHA MIKRO ANDA, PT - ALI0005806
GAFFA ZIY RS. JAKARTA REKAN USAHA MIKRO ANDA, PT - ALI0005806
RONAIDA P RS. COLUMBIAHOSPITAL & SURGICAL CARE PREMIER - HSAC_IND
LIE SUK FU TZU CHI HOSPI
HS CARE PREMIER XTRA - HSCPX_IND
OLIVIA FR RS. COLUMBIAHS CARE PREMIER XTRA - HSCPX_IND
RADITYA N RS. TELOGOREHOSPITAL & SURGICAL CARE PREMIER PLUS - HSRP_IND
NYSSA FELI TZU CHI HOSPI
HOSPITAL & SURGICAL CARE PREMIER PLUS - HSRP_IND
XANDER KHRSIA. ANUGER HOSPITAL & SURGICAL CARE PREMIER PLUS - HSRP_IND
TJHIN NGIT TZU CHI HOSPI
HS CARE PREMIER XTRA - HSCPX_IND
KALYANA NRS. CIPUTRAHOSPITAL & SURGICAL CARE PREMIER PLUS - HSRP_IND
EKA PUTRI RS. CIPUTRAHRNET RIMBUN INDONESIA GROUP - ALI0005516
RIZAL GIBR RS. BRAWIJAY
HOSPITAL & SURGICAL CARE PREMIER PLUS - HSRP_IND
GHAVYN EL RS. PONDOKHOSPITAL
I & SURGICAL CARE PREMIER PLUS - HSRP_IND
AMELIA YULRS. SURYA HUHOSPITAL & SURGICAL CARE PREMIER PLUS - HSRP_IND
NI WAYAN WBALI ROYAL YAYASAN
H BALI INTERNATIONAL SCH - ALI0005702
LOVIELYN SEKA HOSPITALSMART HEALTH CARE PLUS - HSSM_IND
ALIAN RS. AWAL BRO
HS CARE PREMIER XTRA - HSCPX_IND
NELSON HA RS. MITRA KEHS CARE PREMIER XTRA - HSCPX_IND
NICHOLAS STZU CHI HOSPI
HOSPITAL & SURGICAL CARE PREMIER PLUS - HSRP_IND
FUAD FARIZRS. PONDOKSMART
I HEALTH CARE PLUS - HSSM_IND
EVERLIEN SSILOAM HOSPIH&S INDIVIDU - H&S_IND
KEANA NIL RS. PURA RAHH&SR1 INDIVIDU - H&SR1_IND
 GRACIA MU SILOAM HOSPIHOSPITAL & SURGICAL CARE PREMIER PLUS - HSRP_IND
ASIHOT MARRSU. MITRA HSM CARE PREMIER XTRA - HSCPX_IND
YULIANA E SILOAM HOSPIHS CARE PREMIER XTRA - HSCPX_IND
THET HTAR SILOAM HOSPISMART HEALTH CARE PLUS - HSSM_IND
BUDI HARY RS. PERMATA MARUKA INDONESIA, PT - ALI0004412
JESSICA C RS. SANTA CLHS CARE PREMIER XTRA - HSCPX_IND
FITRI APRIY MAYAPADA HO
ALLIANZ BANCASSURANCE SALES FO - ALI0004398
SAMSUL MITRA KELUAR
NUTRA HERBAL INDONESIA (GROUP) - ALI0005855
YOHANDI RS. CIPUTRAH&S INDIVIDU - H&S_IND
BENEDICTUS RS. EMC ALAM
SMART HEALTH CARE PLUS - HSSM_IND
ALICE NAL RS. PONDOKALLIANZ
I INDIVIDU - INDIVIDU
HEAVEN SK RS. PANTAI IHS CARE PREMIER XTRA - HSCPX_IND
IFFA NURAFRS. JAKARTA REKAN USAHA MIKRO ANDA, PT - ALI0005806
ALIF BERYL RS. PRIMAYAHOSPITAL & SURGICAL CARE PREMIER PLUS - HSRP_IND
RAYCHELLERS. MITRA KE HOSPITAL & SURGICAL CARE PREMIER PLUS - HSRP_IND
RYAN PRIJARS. BRAWIJAYBUMI BERKAH BOGA, PT - ALI0004764
JUNAIDI RS. PERMATA
PRODUCT HSCPP REVAMP - HSRPRV_IND
DAVINO AR RS. TIARA SEL
HS OPTION AGE - H&SO_IND
ENZO IMMA RS. PRIMAYA HS CARE PREMIER XTRA - HSCPX_IND
MUHAMMADRS. HERMINA PT WELL HARVEST WINNING ALUMINA REFINERY - ALI0005767
ARIELLA NA RS. PRIMA MED
H&S INDIVIDU - H&S_IND
GWYNETH TSILOAM HOSPI HOSPITAL & SURGICAL CARE PREMIER PLUS - HSRP_IND
KRISTIAN RS. COLUMBIA HOSPITAL & SURGICAL CARE PREMIER - HSAC_IND
RAJENDRA OVERSEAS ADM HOSPITAL & SURGICAL CARE PREMIER - HSAC_IND
ELTY OVERSEAS ADM
HOSPITAL & SURGICAL CARE PREMIER PLUS - HSRP_IND

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