Hal.

1/14

UMPAN BALIK HASIL VERIFIKASI

Nama RS : RSUD dr. ZAINAL UMAR SIDIKI - KAB. GORONTALO UTARA

Tingkat Pelayanan : RJTL
Bulan Pelayanan : April 2018

No No.SEP Tgl. Verifikasi Biaya

Diajukan Disetujui
1 0463R0000418V000001 2018-07-17 178,300 178,300
2 0463R0000418V000003 2018-07-17 178,300 178,300
3 0463R0000418V000004 2018-07-17 180,200 180,200
4 0463R0000418V000005 2018-07-17 178,300 178,300
5 0463R0000418V000006 2018-07-17 323,000 323,000
6 0463R0000418V000007 2018-07-17 175,500 175,500
7 0463R0000418V000008 2018-07-17 284,800 284,800
8 0463R0000418V000010 2018-07-17 178,300 178,300
9 0463R0000418V000011 2018-07-17 119,000 119,000
10 0463R0000418V000012 2018-07-17 178,300 178,300
11 0463R0000418V000013 2018-07-17 178,300 178,300
12 0463R0000418V000015 2018-07-17 175,500 175,500
13 0463R0000418V000017 2018-07-17 178,300 178,300
14 0463R0000418V000018 2018-07-17 284,800 284,800
15 0463R0000418V000019 2018-07-17 178,300 178,300
16 0463R0000418V000020 2018-07-17 178,300 178,300
17 0463R0000418V000021 2018-07-17 284,800 284,800
18 0463R0000418V000022 2018-07-17 178,300 178,300
19 0463R0000418V000024 2018-07-17 278,100 278,100
20 0463R0000418V000033 2018-07-17 296,400 296,400
21 0463R0000418V000034 2018-07-17 284,800 284,800
22 0463R0000418V000035 2018-07-17 284,800 284,800
23 0463R0000418V000038 2018-07-17 284,800 284,800
24 0463R0000418V000040 2018-07-17 178,300 178,300
25 0463R0000418V000041 2018-07-17 196,700 196,700
26 0463R0000418V000042 2018-07-17 175,500 175,500
27 0463R0000418V000045 2018-07-17 198,600 198,600
28 0463R0000418V000046 2018-07-17 178,300 178,300
29 0463R0000418V000048 2018-07-17 178,300 178,300
30 0463R0000418V000051 2018-07-17 323,000 323,000
31 0463R0000418V000052 2018-07-17 175,500 175,500
32 0463R0000418V000053 2018-07-17 178,300 178,300
 Hal.2/14

UMPAN BALIK HASIL VERIFIKASI

Nama RS : RSUD dr. ZAINAL UMAR SIDIKI - KAB. GORONTALO UTARA

Tingkat Pelayanan : RJTL
Bulan Pelayanan : April 2018

33 0463R0000418V000054 2018-07-17 178,300 178,300

34 0463R0000418V000056 2018-07-17 178,300 178,300
35 0463R0000418V000057 2018-07-17 118,500 118,500
36 0463R0000418V000060 2018-07-17 178,300 178,300
37 0463R0000418V000061 2018-07-17 284,800 284,800
38 0463R0000418V000062 2018-07-17 180,200 180,200
39 0463R0000418V000063 2018-07-17 284,800 284,800
40 0463R0000418V000064 2018-07-17 284,800 284,800
41 0463R0000418V000065 2018-07-17 178,300 178,300
42 0463R0000418V000066 2018-07-17 178,300 178,300
43 0463R0000418V000067 2018-07-17 178,300 178,300
44 0463R0000418V000068 2018-07-17 178,300 178,300
45 0463R0000418V000069 2018-07-17 178,300 178,300
46 0463R0000418V000071 2018-07-17 178,300 178,300
47 0463R0000418V000073 2018-07-17 178,300 178,300
48 0463R0000418V000074 2018-07-17 278,100 278,100
49 0463R0000418V000076 2018-07-17 178,300 178,300
50 0463R0000418V000077 2018-07-17 178,300 178,300
51 0463R0000418V000078 2018-07-17 119,000 119,000
52 0463R0000418V000080 2018-07-17 178,300 178,300
53 0463R0000418V000081 2018-07-17 284,800 284,800
54 0463R0000418V000082 2018-07-17 284,800 284,800
55 0463R0000418V000085 2018-07-17 178,300 178,300
56 0463R0000418V000087 2018-07-17 178,300 178,300
57 0463R0000418V000090 2018-07-17 178,300 178,300
58 0463R0000418V000091 2018-07-17 284,800 284,800
59 0463R0000418V000092 2018-07-17 178,300 178,300
60 0463R0000418V000093 2018-07-17 178,300 178,300
61 0463R0000418V000094 2018-07-17 284,800 284,800
62 0463R0000418V000095 2018-07-17 284,800 284,800
63 0463R0000418V000097 2018-07-17 178,300 178,300
64 0463R0000418V000098 2018-07-17 178,300 178,300
65 0463R0000418V000099 2018-07-17 284,800 284,800
66 0463R0000418V000100 2018-07-17 178,300 178,300
 Hal.3/14

UMPAN BALIK HASIL VERIFIKASI

Nama RS : RSUD dr. ZAINAL UMAR SIDIKI - KAB. GORONTALO UTARA

Tingkat Pelayanan : RJTL
Bulan Pelayanan : April 2018

67 0463R0000418V000101 2018-07-17 178,300 178,300

68 0463R0000418V000102 2018-07-17 284,800 284,800
69 0463R0000418V000104 2018-07-17 284,800 284,800
70 0463R0000418V000106 2018-07-17 284,800 284,800
71 0463R0000418V000110 2018-07-17 284,800 284,800
72 0463R0000418V000111 2018-07-17 284,800 284,800
73 0463R0000418V000116 2018-07-17 284,800 284,800
74 0463R0000418V000118 2018-07-17 232,600 232,600
75 0463R0000418V000119 2018-07-17 284,800 284,800
76 0463R0000418V000120 2018-07-17 178,300 178,300
77 0463R0000418V000121 2018-07-17 284,800 284,800
78 0463R0000418V000122 2018-07-17 178,300 178,300
79 0463R0000418V000125 2018-07-17 178,300 178,300
80 0463R0000418V000126 2018-07-17 178,300 178,300
81 0463R0000418V000128 2018-07-17 178,300 178,300
82 0463R0000418V000129 2018-07-17 500,700 500,700
83 0463R0000418V000130 2018-07-17 232,600 232,600
84 0463R0000418V000133 2018-07-17 178,300 178,300
85 0463R0000418V000134 2018-07-17 178,300 178,300
86 0463R0000418V000135 2018-07-17 178,300 178,300
87 0463R0000418V000136 2018-07-17 178,300 178,300
88 0463R0000418V000137 2018-07-17 284,800 284,800
89 0463R0000418V000138 2018-07-17 272,700 272,700
90 0463R0000418V000139 2018-07-17 284,800 284,800
91 0463R0000418V000140 2018-07-17 284,800 284,800
92 0463R0000418V000141 2018-07-17 178,300 178,300
93 0463R0000418V000142 2018-07-17 178,300 178,300
94 0463R0000418V000148 2018-07-17 178,300 178,300
95 0463R0000418V000149 2018-07-17 178,300 178,300
96 0463R0000418V000151 2018-07-17 178,300 178,300
97 0463R0000418V000155 2018-07-17 178,300 178,300
98 0463R0000418V000156 2018-07-17 178,300 178,300
99 0463R0000418V000157 2018-07-17 178,300 178,300
100 0463R0000418V000158 2018-07-17 178,300 178,300
 Hal.4/14

UMPAN BALIK HASIL VERIFIKASI

Nama RS : RSUD dr. ZAINAL UMAR SIDIKI - KAB. GORONTALO UTARA

Tingkat Pelayanan : RJTL
Bulan Pelayanan : April 2018

101 0463R0000418V000159 2018-07-17 178,300 178,300

102 0463R0000418V000160 2018-07-17 147,600 147,600
103 0463R0000418V000161 2018-07-17 127,000 127,000
104 0463R0000418V000163 2018-07-17 284,800 284,800
105 0463R0000418V000164 2018-07-17 178,300 178,300
106 0463R0000418V000165 2018-07-17 178,300 178,300
107 0463R0000418V000166 2018-07-17 178,300 178,300
108 0463R0000418V000167 2018-07-17 284,800 284,800
109 0463R0000418V000168 2018-07-17 284,800 284,800
110 0463R0000418V000172 2018-07-17 178,300 178,300
111 0463R0000418V000182 2018-07-17 178,300 178,300
112 0463R0000418V000183 2018-07-17 278,100 278,100
113 0463R0000418V000184 2018-07-17 178,300 178,300
114 0463R0000418V000189 2018-07-17 178,300 178,300
115 0463R0000418V000190 2018-07-17 178,300 178,300
116 0463R0000418V000191 2018-07-17 178,300 178,300
117 0463R0000418V000192 2018-07-17 110,400 110,400
118 0463R0000418V000196 2018-07-17 278,100 278,100
119 0463R0000418V000197 2018-07-17 147,600 147,600
120 0463R0000418V000199 2018-07-17 178,300 178,300
121 0463R0000418V000203 2018-07-17 232,600 232,600
122 0463R0000418V000204 2018-07-17 175,500 175,500
123 0463R0000418V000205 2018-07-17 323,000 323,000
124 0463R0000418V000206 2018-07-17 178,300 178,300
125 0463R0000418V000207 2018-07-17 196,700 196,700
126 0463R0000418V000208 2018-07-17 178,300 178,300
127 0463R0000418V000209 2018-07-17 232,600 232,600
128 0463R0000418V000210 2018-07-17 178,300 178,300
129 0463R0000418V000211 2018-07-17 196,700 196,700
130 0463R0000418V000212 2018-07-17 178,300 178,300
131 0463R0000418V000213 2018-07-17 178,300 178,300
132 0463R0000418V000214 2018-07-17 178,300 178,300
133 0463R0000418V000215 2018-07-17 178,300 178,300
134 0463R0000418V000216 2018-07-17 284,800 284,800
 Hal.5/14

UMPAN BALIK HASIL VERIFIKASI

Nama RS : RSUD dr. ZAINAL UMAR SIDIKI - KAB. GORONTALO UTARA

Tingkat Pelayanan : RJTL
Bulan Pelayanan : April 2018

135 0463R0000418V000217 2018-07-17 178,300 178,300

136 0463R0000418V000218 2018-07-17 128,300 128,300
137 0463R0000418V000219 2018-07-17 178,300 178,300
138 0463R0000418V000220 2018-07-17 178,300 178,300
139 0463R0000418V000221 2018-07-17 178,300 178,300
140 0463R0000418V000222 2018-07-17 178,300 178,300
141 0463R0000418V000223 2018-07-17 284,800 284,800
142 0463R0000418V000225 2018-07-17 175,500 175,500
143 0463R0000418V000226 2018-07-17 178,300 178,300
144 0463R0000418V000227 2018-07-17 284,800 284,800
145 0463R0000418V000228 2018-07-17 284,800 284,800
146 0463R0000418V000229 2018-07-17 284,800 284,800
147 0463R0000418V000234 2018-07-17 119,000 119,000
148 0463R0000418V000235 2018-07-17 284,800 284,800
149 0463R0000418V000236 2018-07-17 178,300 178,300
150 0463R0000418V000237 2018-07-17 178,300 178,300
151 0463R0000418V000238 2018-07-17 284,800 284,800
152 0463R0000418V000239 2018-07-17 178,300 178,300
153 0463R0000418V000241 2018-07-17 178,300 178,300
154 0463R0000418V000242 2018-07-17 178,300 178,300
155 0463R0000418V000243 2018-07-17 178,300 178,300
156 0463R0000418V000244 2018-07-17 284,800 284,800
157 0463R0000418V000245 2018-07-17 284,800 284,800
158 0463R0000418V000246 2018-07-17 119,000 119,000
159 0463R0000418V000247 2018-07-17 284,800 284,800
160 0463R0000418V000248 2018-07-17 284,800 284,800
161 0463R0000418V000249 2018-07-17 175,500 175,500
162 0463R0000418V000250 2018-07-17 284,800 284,800
163 0463R0000418V000251 2018-07-17 175,500 175,500
164 0463R0000418V000252 2018-07-17 178,300 178,300
165 0463R0000418V000253 2018-07-17 178,300 178,300
166 0463R0000418V000254 2018-07-17 284,800 284,800
167 0463R0000418V000255 2018-07-17 284,800 284,800
168 0463R0000418V000256 2018-07-17 178,300 178,300
 Hal.6/14

UMPAN BALIK HASIL VERIFIKASI

Nama RS : RSUD dr. ZAINAL UMAR SIDIKI - KAB. GORONTALO UTARA

Tingkat Pelayanan : RJTL
Bulan Pelayanan : April 2018

169 0463R0000418V000257 2018-07-17 284,800 284,800

170 0463R0000418V000258 2018-07-17 284,800 284,800
171 0463R0000418V000263 2018-07-17 178,300 178,300
172 0463R0000418V000264 2018-07-17 178,300 178,300
173 0463R0000418V000266 2018-07-17 178,300 178,300
174 0463R0000418V000267 2018-07-17 178,300 178,300
175 0463R0000418V000268 2018-07-17 180,200 180,200
176 0463R0000418V000269 2018-07-17 178,300 178,300
177 0463R0000418V000270 2018-07-17 284,800 284,800
178 0463R0000418V000271 2018-07-17 178,300 178,300
179 0463R0000418V000272 2018-07-17 178,300 178,300
180 0463R0000418V000273 2018-07-17 284,800 284,800
181 0463R0000418V000274 2018-07-17 284,800 284,800
182 0463R0000418V000275 2018-07-17 178,300 178,300
183 0463R0000418V000279 2018-07-17 178,300 178,300
184 0463R0000418V000280 2018-07-17 198,600 198,600
185 0463R0000418V000281 2018-07-17 178,300 178,300
186 0463R0000418V000282 2018-07-17 284,800 284,800
187 0463R0000418V000283 2018-07-17 178,300 178,300
188 0463R0000418V000284 2018-07-17 178,300 178,300
189 0463R0000418V000285 2018-07-17 178,300 178,300
190 0463R0000418V000286 2018-07-17 178,300 178,300
191 0463R0000418V000289 2018-07-17 178,300 178,300
192 0463R0000418V000290 2018-07-17 178,300 178,300
193 0463R0000418V000291 2018-07-17 284,800 284,800
194 0463R0000418V000292 2018-07-17 178,300 178,300
195 0463R0000418V000293 2018-07-17 127,000 127,000
196 0463R0000418V000302 2018-07-17 147,600 147,600
197 0463R0000418V000307 2018-07-17 178,300 178,300
198 0463R0000418V000310 2018-07-17 284,800 284,800
199 0463R0000418V000312 2018-07-17 178,300 178,300
200 0463R0000418V000313 2018-07-17 284,800 284,800
201 0463R0000418V000316 2018-07-17 178,300 178,300
202 0463R0000418V000317 2018-07-17 178,300 178,300
 Hal.7/14

UMPAN BALIK HASIL VERIFIKASI

Nama RS : RSUD dr. ZAINAL UMAR SIDIKI - KAB. GORONTALO UTARA

Tingkat Pelayanan : RJTL
Bulan Pelayanan : April 2018

203 0463R0000418V000318 2018-07-17 284,800 284,800

204 0463R0000418V000321 2018-07-17 178,300 178,300
205 0463R0000418V000323 2018-07-17 284,800 284,800
206 0463R0000418V000324 2018-07-17 178,300 178,300
207 0463R0000418V000325 2018-07-17 178,300 178,300
208 0463R0000418V000326 2018-07-17 178,300 178,300
209 0463R0000418V000327 2018-07-17 284,800 284,800
210 0463R0000418V000328 2018-07-17 284,800 284,800
211 0463R0000418V000329 2018-07-17 284,800 284,800
212 0463R0000418V000330 2018-07-17 178,300 178,300
213 0463R0000418V000332 2018-07-17 284,800 284,800
214 0463R0000418V000338 2018-07-17 178,300 178,300
215 0463R0000418V000340 2018-07-17 175,500 175,500
216 0463R0000418V000341 2018-07-17 323,000 323,000
217 0463R0000418V000343 2018-07-17 232,600 232,600
218 0463R0000418V000344 2018-07-17 178,300 178,300
219 0463R0000418V000345 2018-07-17 119,000 119,000
220 0463R0000418V000346 2018-07-17 178,300 178,300
221 0463R0000418V000349 2018-07-17 175,500 175,500
222 0463R0000418V000350 2018-07-17 178,300 178,300
223 0463R0000418V000352 2018-07-17 178,300 178,300
224 0463R0000418V000353 2018-07-17 178,300 178,300
225 0463R0000418V000355 2018-07-17 178,300 178,300
226 0463R0000418V000356 2018-07-17 178,300 178,300
227 0463R0000418V000357 2018-07-17 284,800 284,800
228 0463R0000418V000358 2018-07-17 284,800 284,800
229 0463R0000418V000359 2018-07-17 272,700 272,700
230 0463R0000418V000360 2018-07-17 178,300 178,300
231 0463R0000418V000361 2018-07-17 284,800 284,800
232 0463R0000418V000362 2018-07-17 232,600 232,600
233 0463R0000418V000363 2018-07-17 284,800 284,800
234 0463R0000418V000364 2018-07-17 284,800 284,800
235 0463R0000418V000365 2018-07-17 178,300 178,300
236 0463R0000418V000366 2018-07-17 178,300 178,300
 Hal.8/14

UMPAN BALIK HASIL VERIFIKASI

Nama RS : RSUD dr. ZAINAL UMAR SIDIKI - KAB. GORONTALO UTARA

Tingkat Pelayanan : RJTL
Bulan Pelayanan : April 2018

237 0463R0000418V000367 2018-07-17 284,800 284,800

238 0463R0000418V000368 2018-07-17 284,800 284,800
239 0463R0000418V000369 2018-07-17 284,800 284,800
240 0463R0000418V000372 2018-07-17 278,100 278,100
241 0463R0000418V000374 2018-07-17 175,500 175,500
242 0463R0000418V000377 2018-07-17 296,400 296,400
243 0463R0000418V000378 2018-07-17 296,400 296,400
244 0463R0000418V000379 2018-07-17 178,300 178,300
245 0463R0000418V000380 2018-07-17 178,300 178,300
246 0463R0000418V000381 2018-07-17 178,300 178,300
247 0463R0000418V000384 2018-07-17 178,300 178,300
248 0463R0000418V000385 2018-07-17 178,300 178,300
249 0463R0000418V000388 2018-07-17 284,800 284,800
250 0463R0000418V000390 2018-07-17 175,500 175,500
251 0463R0000418V000391 2018-07-17 284,800 284,800
252 0463R0000418V000392 2018-07-17 175,500 175,500
253 0463R0000418V000393 2018-07-17 175,500 175,500
254 0463R0000418V000396 2018-07-17 284,800 284,800
255 0463R0000418V000397 2018-07-17 178,300 178,300
256 0463R0000418V000400 2018-07-17 178,300 178,300
257 0463R0000418V000401 2018-07-17 178,300 178,300
258 0463R0000418V000402 2018-07-17 284,800 284,800
259 0463R0000418V000404 2018-07-17 178,300 178,300
260 0463R0000418V000405 2018-07-17 178,300 178,300
261 0463R0000418V000406 2018-07-17 127,000 127,000
262 0463R0000418V000408 2018-07-17 284,800 284,800
263 0463R0000418V000410 2018-07-17 500,700 500,700
264 0463R0000418V000411 2018-07-17 175,500 175,500
265 0463R0000418V000415 2018-07-17 347,000 347,000
266 0463R0000418V000417 2018-07-17 178,300 178,300
267 0463R0000418V000419 2018-07-17 175,500 175,500
268 0463R0000418V000422 2018-07-17 323,000 323,000
269 0463R0000418V000424 2018-07-17 178,300 178,300
270 0463R0000418V000425 2018-07-17 232,600 232,600
 Hal.9/14

UMPAN BALIK HASIL VERIFIKASI

Nama RS : RSUD dr. ZAINAL UMAR SIDIKI - KAB. GORONTALO UTARA

Tingkat Pelayanan : RJTL
Bulan Pelayanan : April 2018

271 0463R0000418V000426 2018-07-17 178,300 178,300

272 0463R0000418V000427 2018-07-17 178,300 178,300
273 0463R0000418V000431 2018-07-17 178,300 178,300
274 0463R0000418V000444 2018-07-17 178,300 178,300
275 0463R0000418V000445 2018-07-17 196,700 196,700
276 0463R0000418V000448 2018-07-17 178,300 178,300
277 0463R0000418V000449 2018-07-17 178,300 178,300
278 0463R0000418V000452 2018-07-17 178,300 178,300
279 0463R0000418V000453 2018-07-17 178,300 178,300
280 0463R0000418V000454 2018-07-17 178,300 178,300
281 0463R0000418V000455 2018-07-17 178,300 178,300
282 0463R0000418V000456 2018-07-17 178,300 178,300
283 0463R0000418V000457 2018-07-17 178,300 178,300
284 0463R0000418V000464 2018-07-17 178,300 178,300
285 0463R0000418V000465 2018-07-17 178,300 178,300
286 0463R0000418V000466 2018-07-17 178,300 178,300
287 0463R0000418V000467 2018-07-17 178,300 178,300
288 0463R0000418V000468 2018-07-17 284,800 284,800
289 0463R0000418V000469 2018-07-17 178,300 178,300
290 0463R0000418V000470 2018-07-17 178,300 178,300
291 0463R0000418V000471 2018-07-17 178,300 178,300
292 0463R0000418V000472 2018-07-17 284,800 284,800
293 0463R0000418V000473 2018-07-17 178,300 178,300
294 0463R0000418V000475 2018-07-17 178,300 178,300
295 0463R0000418V000476 2018-07-17 284,800 284,800
296 0463R0000418V000479 2018-07-17 178,300 178,300
297 0463R0000418V000480 2018-07-17 232,600 232,600
298 0463R0000418V000481 2018-07-17 178,300 178,300
299 0463R0000418V000483 2018-07-17 178,300 178,300
300 0463R0000418V000484 2018-07-17 236,200 236,200
301 0463R0000418V000485 2018-07-17 178,300 178,300
302 0463R0000418V000486 2018-07-17 284,800 284,800
303 0463R0000418V000487 2018-07-17 284,800 284,800
304 0463R0000418V000488 2018-07-17 178,300 178,300
 Hal.10/14

UMPAN BALIK HASIL VERIFIKASI

Nama RS : RSUD dr. ZAINAL UMAR SIDIKI - KAB. GORONTALO UTARA

Tingkat Pelayanan : RJTL
Bulan Pelayanan : April 2018

305 0463R0000418V000489 2018-07-17 178,300 178,300

306 0463R0000418V000490 2018-07-17 178,300 178,300
307 0463R0000418V000495 2018-07-17 251,800 251,800
308 0463R0000418V000496 2018-07-17 178,300 178,300
309 0463R0000418V000497 2018-07-17 178,300 178,300
310 0463R0000418V000498 2018-07-17 178,300 178,300
311 0463R0000418V000500 2018-07-17 178,300 178,300
312 0463R0000418V000501 2018-07-17 178,300 178,300
313 0463R0000418V000502 2018-07-17 178,300 178,300
314 0463R0000418V000503 2018-07-17 178,300 178,300
315 0463R0000418V000505 2018-07-17 178,300 178,300
316 0463R0000418V000510 2018-07-17 178,300 178,300
317 0463R0000418V000513 2018-07-17 284,800 284,800
318 0463R0000418V000518 2018-07-17 178,300 178,300
319 0463R0000418V000519 2018-07-17 284,800 284,800
320 0463R0000418V000520 2018-07-17 175,500 175,500
321 0463R0000418V000521 2018-07-17 178,300 178,300
322 0463R0000418V000523 2018-07-17 178,300 178,300
323 0463R0000418V000524 2018-07-17 178,300 178,300
324 0463R0000418V000525 2018-07-17 178,300 178,300
325 0463R0000418V000526 2018-07-17 178,300 178,300
326 0463R0000418V000527 2018-07-17 178,300 178,300
327 0463R0000418V000528 2018-07-17 284,800 284,800
328 0463R0000418V000529 2018-07-17 236,200 236,200
329 0463R0000418V000531 2018-07-17 178,300 178,300
330 0463R0000418V000534 2018-07-17 121,300 121,300
331 0463R0000418V000535 2018-07-17 196,700 196,700
332 0463R0000418V000539 2018-07-17 178,300 178,300
333 0463R0000418V000543 2018-07-17 178,300 178,300
334 0463R0000418V000544 2018-07-17 175,500 175,500
335 0463R0000418V000547 2018-07-17 178,300 178,300
336 0463R0000418V000548 2018-07-17 178,300 178,300
337 0463R0000418V000549 2018-07-17 175,500 175,500
338 0463R0000418V000557 2018-07-17 272,700 272,700
 Hal.11/14

UMPAN BALIK HASIL VERIFIKASI

Nama RS : RSUD dr. ZAINAL UMAR SIDIKI - KAB. GORONTALO UTARA

Tingkat Pelayanan : RJTL
Bulan Pelayanan : April 2018

339 0463R0000418V000558 2018-07-17 178,300 178,300

340 0463R0000418V000559 2018-07-17 175,500 175,500
341 0463R0000418V000560 2018-07-17 178,300 178,300
342 0463R0000418V000561 2018-07-17 178,300 178,300
343 0463R0000418V000562 2018-07-17 178,300 178,300
344 0463R0000418V000563 2018-07-17 178,300 178,300
345 0463R0000418V000564 2018-07-17 175,500 175,500
346 0463R0000418V000565 2018-07-17 178,300 178,300
347 0463R0000418V000566 2018-07-17 178,300 178,300
348 0463R0000418V000573 2018-07-17 175,500 175,500
349 0463R0000418V000574 2018-07-17 175,500 175,500
350 0463R0000418V000575 2018-07-17 127,000 127,000
351 0463R0000418V000576 2018-07-17 147,600 147,600
352 0463R0000418V000577 2018-07-17 296,400 296,400
353 0463R0000418V000578 2018-07-17 175,500 175,500
354 0463R0000418V000579 2018-07-17 175,500 175,500
355 0463R0000418V000582 2018-07-17 178,300 178,300
356 0463R0000418V000584 2018-07-17 236,200 236,200
357 0463R0000418V000586 2018-07-17 284,800 284,800
358 0463R0000418V000587 2018-07-17 178,300 178,300
359 0463R0000418V000588 2018-07-17 178,300 178,300
360 0463R0000418V000589 2018-07-17 119,000 119,000
361 0463R0000418V000590 2018-07-17 178,300 178,300
362 0463R0000418V000591 2018-07-17 284,800 284,800
363 0463R0000418V000592 2018-07-17 284,800 284,800
364 0463R0000418V000593 2018-07-17 284,800 284,800
365 0463R0000418V000594 2018-07-17 284,800 284,800
366 0463R0000418V000595 2018-07-17 178,300 178,300
367 0463R0000418V000596 2018-07-17 284,800 284,800
368 0463R0000418V000597 2018-07-17 178,300 178,300
369 0463R0000418V000600 2018-07-17 284,800 284,800
370 0463R0000418V000601 2018-07-17 178,300 178,300
371 0463R0000418V000602 2018-07-17 178,300 178,300
372 0463R0000418V000603 2018-07-17 178,300 178,300
 Hal.12/14

UMPAN BALIK HASIL VERIFIKASI

Nama RS : RSUD dr. ZAINAL UMAR SIDIKI - KAB. GORONTALO UTARA

Tingkat Pelayanan : RJTL
Bulan Pelayanan : April 2018

373 0463R0000418V000604 2018-07-17 178,300 178,300

374 0463R0000418V000611 2018-07-17 284,800 284,800
375 0463R0000418V000612 2018-07-17 178,300 178,300
376 0463R0000418V000614 2018-07-17 284,800 284,800
377 0463R0000418V000615 2018-07-17 284,800 284,800
378 0463R0000418V000616 2018-07-17 178,300 178,300
379 0463R0000418V000617 2018-07-17 178,300 178,300
380 0463R0000418V000618 2018-07-17 284,800 284,800
381 0463R0000418V000619 2018-07-17 284,800 284,800
382 0463R0000418V000622 2018-07-17 284,800 284,800
383 0463R0000418V000623 2018-07-17 251,800 251,800
384 0463R0000418V000638 2018-07-17 178,300 178,300
385 0463R0000418V000639 2018-07-17 178,300 178,300
386 0463R0000418V000640 2018-07-17 284,800 284,800
387 0463R0000418V000641 2018-07-17 178,300 178,300
388 0463R0000418V000642 2018-07-17 178,300 178,300
389 0463R0000418V000643 2018-07-17 178,300 178,300
390 0463R0000418V000644 2018-07-17 178,300 178,300
391 0463R0000418V000645 2018-07-17 178,300 178,300
392 0463R0000418V000646 2018-07-17 284,800 284,800
393 0463R0000418V000647 2018-07-17 178,300 178,300
394 0463R0000418V000648 2018-07-17 278,100 278,100
395 0463R0000418V000650 2018-07-17 178,300 178,300
396 0463R0000418V000651 2018-07-17 178,300 178,300
397 0463R0000418V000652 2018-07-17 178,300 178,300
398 0463R0000418V000654 2018-07-17 178,300 178,300
399 0463R0000418V000656 2018-07-17 284,800 284,800
400 0463R0000418V000658 2018-07-17 178,300 178,300
401 0463R0000418V000659 2018-07-17 284,800 284,800
402 0463R0000418V000660 2018-07-17 284,800 284,800
403 0463R0000418V000661 2018-07-17 178,300 178,300
404 0463R0000418V000662 2018-07-17 178,300 178,300
405 0463R0000418V000663 2018-07-17 178,300 178,300
406 0463R0000418V000673 2018-07-17 240,900 240,900
 Hal.13/14

UMPAN BALIK HASIL VERIFIKASI

Nama RS : RSUD dr. ZAINAL UMAR SIDIKI - KAB. GORONTALO UTARA

Tingkat Pelayanan : RJTL
Bulan Pelayanan : April 2018

407 0463R0000418V000674 2018-07-17 178,300 178,300

408 0463R0000418V000676 2018-07-17 196,700 196,700
409 0463R0000418V000678 2018-07-17 178,300 178,300
410 0463R0000418V000686 2018-07-17 178,300 178,300
411 0463R0000418V000689 2018-07-17 278,100 278,100
412 0463R0000418V000690 2018-07-17 178,300 178,300
413 0463R0000418V000691 2018-07-17 178,300 178,300
414 0463R0000418V000692 2018-07-17 178,300 178,300
415 0463R0000418V000693 2018-07-17 175,500 175,500
416 0463R0000418V000694 2018-07-17 178,300 178,300
417 0463R0000418V000695 2018-07-17 178,300 178,300
418 0463R0000418V000696 2018-07-17 178,300 178,300
419 0463R0000418V000697 2018-07-17 178,300 178,300
420 0463R0000418V000699 2018-07-17 178,300 178,300
421 0463R0000418V000710 2018-07-17 178,300 178,300
422 0463R0000418V000712 2018-07-17 178,300 178,300
423 0463R0000418V000713 2018-07-17 119,000 119,000
424 0463R0000418V000714 2018-07-17 178,300 178,300
425 0463R0000418V000716 2018-07-17 178,300 178,300
426 0463R0000418V000717 2018-07-17 178,300 178,300
427 0463R0000418V000718 2018-07-17 178,300 178,300
428 0463R0000418V000720 2018-07-17 178,300 178,300
429 0463R0000418V000721 2018-07-17 178,300 178,300
430 0463R0000418V000722 2018-07-17 178,300 178,300
431 0463R0000418V000723 2018-07-17 175,500 175,500
432 0463R0000418V000724 2018-07-17 175,500 175,500
433 0463R0000418V000725 2018-07-17 232,600 232,600
434 0463R0000418V000726 2018-07-17 323,000 323,000
435 0463R0000418V000727 2018-07-17 147,600 147,600
436 0463R0000418V000741 2018-07-17 175,500 175,500
437 0463R0000418V000742 2018-07-17 240,900 240,900
438 0463R0000418V000743 2018-07-17 178,300 178,300
439 0463R0000418V000745 2018-07-17 178,300 178,300
440 0463R0000418V000746 2018-07-17 178,300 178,300
 Hal.14/14

UMPAN BALIK HASIL VERIFIKASI

Nama RS : RSUD dr. ZAINAL UMAR SIDIKI - KAB. GORONTALO UTARA

Tingkat Pelayanan : RJTL
Bulan Pelayanan : April 2018

441 0463R0000418V000748 2018-07-17 178,300 178,300

442 0463R0000418V000749 2018-07-17 178,300 178,300
443 0463R0000418V000750 2018-07-17 178,300 178,300
444 0463R0000418V000759 2018-07-17 178,300 178,300
445 0463R0000418V000760 2018-07-17 178,300 178,300
446 0463R0000418V000761 2018-07-17 251,800 251,800
447 0463R0000418V000762 2018-07-17 175,500 175,500
448 0463R0000418V000763 2018-07-17 175,500 175,500
449 0463R0000418V000766 2018-07-17 296,400 296,400
TOTAL 93,710,700 93,710,700

RESUME
Total Bea.Diajukan : 93,710,700
Total Bea.Disetujui : 93,710,700

Menyetujui Mengetahui
Direktur RS BPJS KESEHATAN

Rahmat Mulia Ritonga