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    RptUmpanBalik Jalan

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    Ernie Riezal
    The document is a report from RSB Nabasa hospital that lists 112 patient cases that were verified between October 1-31, 2017. For each case, it includes the patient ID number, date of verification, proposed cost, and approved cost. In all cases, the proposed and approved costs matched. The report provides details of cost verification for patient cases at RSB Nabasa hospital over a one month period in 2017.

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    RptUmpanBalik Jalan

    Uploaded by

    Ernie Riezal
    13 views7 pages
    The document is a report from RSB Nabasa hospital that lists 112 patient cases that were verified between October 1-31, 2017. For each case, it includes the patient ID number, date of verification, proposed cost, and approved cost. In all cases, the proposed and approved costs matched. The report provides details of cost verification for patient cases at RSB Nabasa hospital over a one month period in 2017.

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    The document is a report from RSB Nabasa hospital that lists 112 patient cases that were verified between October 1-31, 2017. For each case, it includes the patient ID number, date of verification, proposed cost, and approved cost. In all cases, the proposed and approved costs matched. The report provides details of cost verification for patient cases at RSB Nabasa hospital over a one month period in 2017.

    Copyright:

    © All Rights Reserved
    Download as XLSX, PDF, TXT or read online from Scribd
    Download as xlsx, pdf, or txt
    13 views7 pages

    RptUmpanBalik Jalan

    Uploaded by

    Ernie Riezal
    The document is a report from RSB Nabasa hospital that lists 112 patient cases that were verified between October 1-31, 2017. For each case, it includes the patient ID number, date of verification, proposed cost, and approved cost. In all cases, the proposed and approved costs matched. The report provides details of cost verification for patient cases at RSB Nabasa hospital over a one month period in 2017.

    Copyright:

    © All Rights Reserved
    Download as XLSX, PDF, TXT or read online from Scribd
    Download as xlsx, pdf, or txt
    of 7

    UMPAN BALIK HASIL VERIFIKASI

    Nama RS : RSB NABASA


    Tingkat Pelayanan : RJTL
    Tgl.Pelayanan : 01 Oktober 2017 s/d 31 Oktober 2017

    No No.SEP Tgl. Verifikasi Biaya


    Diajukan Disetujui
    1 0265R02010170000002 15/11/2017 192,700 192,700
    2 0265R02010170000003 13/11/2017 315,000 315,000
    3 0265R02010170000010 13/11/2017 315,000 315,000
    4 0265R02010170000019 13/11/2017 315,000 315,000
    5 0265R02010170000020 13/11/2017 315,000 315,000
    6 0265R02010170000021 13/11/2017 315,000 315,000
    7 0265R02010170000022 15/11/2017 139,800 139,800
    8 0265R02010170000023 13/11/2017 192,700 192,700
    9 0265R02010170000024 13/11/2017 192,700 192,700
    10 0265R02010170000026 13/11/2017 192,700 192,700
    11 0265R02010170000027 13/11/2017 315,000 315,000
    12 0265R02010170000032 15/11/2017 315,000 315,000
    13 0265R02010170000033 13/11/2017 315,000 315,000
    14 0265R02010170000034 15/11/2017 315,000 315,000
    15 0265R02010170000035 13/11/2017 315,000 315,000
    16 0265R02010170000036 13/11/2017 192,700 192,700
    17 0265R02010170000038 13/11/2017 315,000 315,000
    18 0265R02010170000039 13/11/2017 139,800 139,800
    19 0265R02010170000040 13/11/2017 315,000 315,000
    20 0265R02010170000041 13/11/2017 315,000 315,000
    21 0265R02010170000042 13/11/2017 192,700 192,700
    22 0265R02010170000051 13/11/2017 315,000 315,000
    23 0265R02010170000052 13/11/2017 315,000 315,000
    24 0265R02010170000053 13/11/2017 192,700 192,700
    25 0265R02010170000056 13/11/2017 315,000 315,000
    26 0265R02010170000057 13/11/2017 139,800 139,800
    27 0265R02010170000058 13/11/2017 315,000 315,000
    28 0265R02010170000059 15/11/2017 162,600 162,600
    29 0265R02010170000064 15/11/2017 192,700 192,700
    30 0265R02010170000075 13/11/2017 315,000 315,000
    31 0265R02010170000076 20/11/2017 312,500 312,500
    32 0265R02010170000077 13/11/2017 315,000 315,000
    UMPAN BALIK HASIL VERIFIKASI

    Nama RS : RSB NABASA


    Tingkat Pelayanan : RJTL
    Tgl.Pelayanan : 01 Oktober 2017 s/d 31 Oktober 2017

    33 0265R02010170000078 13/11/2017 315,000 315,000


    34 0265R02010170000080 13/11/2017 194,100 194,100
    35 0265R02010170000083 15/11/2017 192,700 192,700
    36 0265R02010170000096 15/11/2017 315,000 315,000
    37 0265R02010170000097 15/11/2017 315,000 315,000
    38 0265R02010170000098 15/11/2017 315,000 315,000
    39 0265R02010170000100 15/11/2017 315,000 315,000
    40 0265R02010170000101 13/11/2017 315,000 315,000
    41 0265R02010170000102 15/11/2017 315,000 315,000
    42 0265R02010170000110 15/11/2017 139,800 139,800
    43 0265R02010170000112 13/11/2017 192,700 192,700
    44 0265R02010170000113 13/11/2017 192,700 192,700
    45 0265R02010170000114 13/11/2017 192,700 192,700
    46 0265R02010170000115 13/11/2017 192,700 192,700
    47 0265R02010170000120 13/11/2017 315,000 315,000
    48 0265R02010170000121 13/11/2017 315,000 315,000
    49 0265R02010170000122 13/11/2017 315,000 315,000
    50 0265R02010170000123 13/11/2017 315,000 315,000
    51 0265R02010170000126 13/11/2017 315,000 315,000
    52 0265R02010170000127 13/11/2017 315,000 315,000
    53 0265R02010170000134 20/11/2017 192,700 192,700
    54 0265R02010170000135 20/11/2017 315,000 315,000
    55 0265R02010170000137 13/11/2017 315,000 315,000
    56 0265R02010170000138 13/11/2017 315,000 315,000
    57 0265R02010170000139 13/11/2017 315,000 315,000
    58 0265R02010170000141 15/11/2017 315,000 315,000
    59 0265R02010170000145 13/11/2017 315,000 315,000
    60 0265R02010170000146 15/11/2017 315,000 315,000
    61 0265R02010170000151 13/11/2017 139,800 139,800
    62 0265R02010170000152 20/11/2017 139,800 139,800
    63 0265R02010170000153 13/11/2017 192,700 192,700
    64 0265R02010170000154 13/11/2017 312,500 312,500
    65 0265R02010170000155 15/11/2017 312,500 312,500
    66 0265R02010170000156 13/11/2017 192,700 192,700
    UMPAN BALIK HASIL VERIFIKASI

    Nama RS : RSB NABASA


    Tingkat Pelayanan : RJTL
    Tgl.Pelayanan : 01 Oktober 2017 s/d 31 Oktober 2017

    67 0265R02010170000158 20/11/2017 139,800 139,800


    68 0265R02010170000159 15/11/2017 192,700 192,700
    69 0265R02010170000160 13/11/2017 192,700 192,700
    70 0265R02010170000162 13/11/2017 312,500 312,500
    71 0265R02010170000163 15/11/2017 192,700 192,700
    72 0265R02010170000164 15/11/2017 194,100 194,100
    73 0265R02010170000165 15/11/2017 194,100 194,100
    74 0265R02010170000166 13/11/2017 315,000 315,000
    75 0265R02010170000167 13/11/2017 194,100 194,100
    76 0265R02010170000168 15/11/2017 315,000 315,000
    77 0265R02010170000174 15/11/2017 315,000 315,000
    78 0265R02010170000175 15/11/2017 315,000 315,000
    79 0265R02010170000176 15/11/2017 315,000 315,000
    80 0265R02010170000177 15/11/2017 192,700 192,700
    81 0265R02010170000178 15/11/2017 315,000 315,000
    82 0265R02010170000181 15/11/2017 315,000 315,000
    83 0265R02010170000183 15/11/2017 315,000 315,000
    84 0265R02010170000184 13/11/2017 315,000 315,000
    85 0265R02010170000185 13/11/2017 315,000 315,000
    86 0265R02010170000189 13/11/2017 139,800 139,800
    87 0265R02010170000190 13/11/2017 315,000 315,000
    88 0265R02010170000191 24/11/2017 192,700 192,700
    89 0265R02010170000193 13/11/2017 192,700 192,700
    90 0265R02010170000194 13/11/2017 315,000 315,000
    91 0265R02010170000196 13/11/2017 315,000 315,000
    92 0265R02010170000197 13/11/2017 315,000 315,000
    93 0265R02010170000203 13/11/2017 315,000 315,000
    94 0265R02010170000204 13/11/2017 315,000 315,000
    95 0265R02010170000207 13/11/2017 192,700 192,700
    96 0265R02010170000217 24/11/2017 139,800 139,800
    97 0265R02010170000222 24/11/2017 315,000 315,000
    98 0265R02010170000223 15/11/2017 315,000 315,000
    99 0265R02010170000225 15/11/2017 315,000 315,000
    100 0265R02010170000227 15/11/2017 315,000 315,000
    UMPAN BALIK HASIL VERIFIKASI

    Nama RS : RSB NABASA


    Tingkat Pelayanan : RJTL
    Tgl.Pelayanan : 01 Oktober 2017 s/d 31 Oktober 2017

    101 0265R02010170000229 15/11/2017 315,000 315,000


    102 0265R02010170000237 15/11/2017 315,000 315,000
    103 0265R02010170000238 15/11/2017 315,000 315,000
    104 0265R02010170000239 15/11/2017 192,700 192,700
    105 0265R02010170000240 15/11/2017 192,700 192,700
    106 0265R02010170000241 15/11/2017 192,700 192,700
    107 0265R02010170000242 15/11/2017 192,700 192,700
    108 0265R02010170000243 15/11/2017 192,700 192,700
    109 0265R02010170000248 24/11/2017 315,000 315,000
    110 0265R02010170000249 24/11/2017 315,000 315,000
    111 0265R02010170000250 15/11/2017 192,700 192,700
    112 0265R02010170000256 13/11/2017 315,000 315,000
    113 0265R02010170000259 13/11/2017 315,000 315,000
    114 0265R02010170000263 15/11/2017 192,700 192,700
    115 0265R02010170000268 15/11/2017 315,000 315,000
    116 0265R02010170000269 15/11/2017 192,700 192,700
    117 0265R02010170000271 15/11/2017 315,000 315,000
    118 0265R02010170000277 15/11/2017 315,000 315,000
    119 0265R02010170000278 15/11/2017 315,000 315,000
    120 0265R02010170000283 15/11/2017 192,700 192,700
    121 0265R02010170000285 15/11/2017 315,000 315,000
    122 0265R02010170000286 15/11/2017 315,000 315,000
    123 0265R02010170000287 15/11/2017 315,000 315,000
    124 0265R02010170000293 20/11/2017 192,700 192,700
    125 0265R02010170000294 15/11/2017 315,000 315,000
    126 0265R02010170000295 15/11/2017 312,500 312,500
    127 0265R02010170000296 20/11/2017 192,700 192,700
    128 0265R02010170000297 15/11/2017 192,700 192,700
    129 0265R02010170000298 15/11/2017 312,500 312,500
    130 0265R02010170000299 15/11/2017 312,500 312,500
    131 0265R02010170000300 15/11/2017 192,700 192,700
    132 0265R02010170000301 20/11/2017 315,000 315,000
    133 0265R02010170000302 15/11/2017 194,100 194,100
    134 0265R02010170000303 15/11/2017 315,000 315,000
    UMPAN BALIK HASIL VERIFIKASI

    Nama RS : RSB NABASA


    Tingkat Pelayanan : RJTL
    Tgl.Pelayanan : 01 Oktober 2017 s/d 31 Oktober 2017

    135 0265R02010170000304 15/11/2017 192,700 192,700


    136 0265R02010170000306 24/11/2017 312,500 312,500
    137 0265R02010170000307 20/11/2017 139,800 139,800
    138 0265R02010170000314 24/11/2017 192,700 192,700
    139 0265R02010170000315 24/11/2017 315,000 315,000
    140 0265R02010170000316 24/11/2017 315,000 315,000
    141 0265R02010170000317 24/11/2017 315,000 315,000
    142 0265R02010170000320 24/11/2017 315,000 315,000
    143 0265R02010170000321 24/11/2017 315,000 315,000
    144 0265R02010170000323 24/11/2017 315,000 315,000
    145 0265R02010170000324 24/11/2017 315,000 315,000
    146 0265R02010170000326 15/11/2017 315,000 315,000
    147 0265R02010170000327 15/11/2017 192,700 192,700
    148 0265R02010170000328 15/11/2017 192,700 192,700
    149 0265R02010170000329 15/11/2017 192,700 192,700
    150 0265R02010170000334 15/11/2017 315,000 315,000
    151 0265R02010170000336 20/11/2017 315,000 315,000
    152 0265R02010170000341 15/11/2017 315,000 315,000
    153 0265R02010170000342 15/11/2017 315,000 315,000
    154 0265R02010170000344 15/11/2017 192,700 192,700
    155 0265R02010170000348 24/11/2017 315,000 315,000
    156 0265R02010170000356 24/11/2017 315,000 315,000
    157 0265R02010170000364 13/11/2017 192,700 192,700
    158 0265R02010170000370 13/11/2017 192,700 192,700
    159 0265R02010170000371 13/11/2017 192,700 192,700
    160 0265R02010170000375 13/11/2017 192,700 192,700
    161 0265R02010170000376 13/11/2017 315,000 315,000
    162 0265R02010170000378 13/11/2017 192,700 192,700
    163 0265R02010170000384 13/11/2017 192,700 192,700
    164 0265R02010170000394 13/11/2017 315,000 315,000
    165 0265R02010170000409 13/11/2017 192,700 192,700
    166 0265R02010170000410 13/11/2017 315,000 315,000
    167 0265R02010170000412 13/11/2017 315,000 315,000
    168 0265R02010170000413 13/11/2017 315,000 315,000
    UMPAN BALIK HASIL VERIFIKASI

    Nama RS : RSB NABASA


    Tingkat Pelayanan : RJTL
    Tgl.Pelayanan : 01 Oktober 2017 s/d 31 Oktober 2017

    169 0265R02010170000415 13/11/2017 139,800 139,800


    170 0265R02010170000420 13/11/2017 192,700 192,700
    171 0265R02010170000421 13/11/2017 315,000 315,000
    172 0265R02010170000422 13/11/2017 192,700 192,700
    173 0265R02010170000423 13/11/2017 315,000 315,000
    174 0265R02010170000424 13/11/2017 315,000 315,000
    175 0265R02010170000425 13/11/2017 315,000 315,000
    176 0265R02010170000427 13/11/2017 315,000 315,000
    177 0265R02010170000435 13/11/2017 192,700 192,700
    178 0265R02010170000436 13/11/2017 192,700 192,700
    179 0265R02010170000437 13/11/2017 315,000 315,000
    180 0265R02010170000439 13/11/2017 192,700 192,700
    181 0265R02010170000441 13/11/2017 315,000 315,000
    182 0265R02010170000444 13/11/2017 192,700 192,700
    183 0265R02010170000449 13/11/2017 315,000 315,000
    184 0265R02010170000450 13/11/2017 315,000 315,000
    185 0265R02010170000452 13/11/2017 315,000 315,000
    186 0265R02010170000453 13/11/2017 315,000 315,000
    187 0265R02010170000455 13/11/2017 315,000 315,000
    188 0265R02010170000456 13/11/2017 315,000 315,000
    189 0265R02010170000457 13/11/2017 315,000 315,000
    190 0265R02010170000460 13/11/2017 315,000 315,000
    191 0265R02010170000462 13/11/2017 315,000 315,000
    192 0265R02010170000468 24/11/2017 292,700 292,700
    TOTAL 51,027,100 51,027,100
    * SEP Yang Mengalami Penurunan Kelas RS (Tarif Pasien Umum)

    RESUME

    Total Bea.Diajukan : 51,027,100


    Total Bea.Disetujui : 51,027,100

    Menyetujui Mengetahui
    Direktur RS BPJS KESEHATAN
    UMPAN BALIK HASIL VERIFIKASI

    Nama RS : RSB NABASA


    Tingkat Pelayanan : RJTL
    Tgl.Pelayanan : 01 Oktober 2017 s/d 31 Oktober 2017

    Mengetahui
    BPJS KESEHATAN

    Dr. dr. Pinda Hutajulu Sp.OG. K.Fer Syarif Fahrurazi

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