LAPORAN REKAP KLAIM - RSIA SUKMA BUNDA

Pasien Rawat Inap Periode Tanggal Pulang: 1 Jun 2018 s/d 30 Jun 2018

Tarif
No. Tgl. Masuk Tgl. Pulang No. RM Nama Pasien Diagnosa Kelas Tindakan
BPJS
1 30 Mei 2018 1 Jun 2018 012737 YULINDAH NURFITRIANA Iufd 1 drip + hecting 3,158,400
2 30 Mei 2018 2 Jun 2018 010126 GUSMARNI letak sungsang 2 SC 6,023,900
3 30 Mei 2018 1 Jun 2018 011356 MARDIATI oligohidramnion + hypertensi gestasional 3 normal 1,900,300
4 30 Mei 2018 2 Jun 2018 013532 IRA DELIANTI plasenta Previa + preterm 2 SC 6,023,900
5 31 Mei 2018 2 Jun 2018 013468 WIRA SWASTA bekas SC 1 SC 7,027,900
6 30 Mei 2018 2 Jun 2018 012670 SRI AULIA NINGSIH oligohidramnion + gagal drip + fetal distress 3 SC 5,019,900
7 31 Mei 2018 2 Jun 2018 013151 ATIKA NORA NASTI bekas SC 3 SC 5,019,900
8 31 Mei 2018 2 Jun 2018 013305 IRA AZVARINA Kpd + laserasi II 1 drip + hecting 3,158,400
9 30 Mei 2018 2 Jun 2018 002842 DEFI SRI PUTRI bekas SC 2 SC 6,023,900
10 31 Mei 2018 4 Jun 2018 010044 SRIKANDI RAHMASARI bekas SC 2 SC 6,023,900
11 1 Jun 2018 4 Jun 2018 012988 FEBRINA SYNTIA Kpd + gagal drip + posterm 3 SC 5,019,900
12 2 Jun 2018 5 Jun 2018 013369 DESI DARMAYANTI bekas SC 2 SC 6,023,900
13 2 Jun 2018 3 Jun 2018 013806 NOVI YANA abortus inkomplit 3 CURET 1,722,200
14 2 Jun 2018 5 Jun 2018 012456 KHAIRANI bekas SC 2 SC 6,023,900
15 4 Jun 2018 6 Jun 2018 003177 FIRLI ROHIMAH kontraksi 2 SC 6,023,900
16 4 Jun 2018 6 Jun 2018 013616 TIKA SUTRI YENI kontraksi 2 SC 6,023,900
17 2 Jun 2018 4 Jun 2018 013554 ERLINA posterm 3 DRIP 2,256,000
18 4 Jun 2018 7 Jun 2018 013829 MITRA WATI kala II memanjang + fetal disterss 3 SC 5,019,900
19 4 Jun 2018 6 Jun 2018 013326 MARTHA SILVIA ERIDA lilitan tali pusat 2 lahir spontan + epis + hecting 2,254,100
20 5 Jun 2018 9 Jun 2018 013843 ANNISA MARDATILLAH cpd + kpd 2 SC 6,023,900
21 6 Jun 2018 9 Jun 2018 013581 SETRI INDRAWATI bekas SC 2 SC 6,023,900
22 6 Jun 2018 10 Jun 2018 011286 FATMAWATI kpd 3 drip + epis + hecting 2,256,000
23 7 Jun 2018 10 Jun 2018 013533 YULIA SUSWATI plasenta Previa + preterm 3 SC 5,302,400
24 7 Jun 2018 9 Jun 2018 012970 NOFRIKA ELIZA kpd 3 lahir spontan + epis + hecting 2,256,000
25 7 Jun 2018 8 Jun 2018 013886 LOVIA ANDRINA abortus inkomplit 3 CURET 1,722,200
26 8 Jun 2018 9 Jun 2018 010217 YESI KUMALA SARI kpd 3 drip + hecting 2,707,200
27 8 Jun 2018 11 Jun 2018 002264 DIVA PRAYETA bekas SC 2 SC 5,019,900
 Tarif
No. Tgl. Masuk Tgl. Pulang No. RM Nama Pasien Diagnosa Kelas Tindakan
BPJS
28 9 Jun 2018 11 Jun 2018 013295 WIDYA RESTI AGUSTIN bekas SC 1 SC 7,027,900
29 9 Jun 2018 11 Jun 2018 000972 YUSNIVIANTI bekas SC 2 SC 6,023,900
30 9 Jun 2018 13 Jun 2018 013796 YOSI ZULHIJAH Heg + abortus iminens 1 RAWAT 2,909,700
31 10 Jun 2018 13 Jun 2018 013787 LENI LESTARI kontraksi 3 SC 5,019,900
32 10 Jun 2018 13 Jun 2018 013943 FAUZIAH KURNIA kpd 3 drip + epis + hecting 2,256,000
33 10 Jun 2018 14 Jun 2018 013887 FEBRINA ELSIA Heg 2 RAWAT 2,494,100
34 10 Jun 2018 12 Jun 2018 013946 SURYATI GUSPITA kpd 3 drip + epis + hecting 2,256,000
35 11 Jun 2018 13 Jun 2018 006761 RESTI SUCIA NINGSIH kpd 3 drip + epis + hecting 2,256,000
36 11 Jun 2018 13 Jun 2018 012454 ILMA GUSNETI SC + Steril 1 SC 7,027,900
37 10 Jun 2018 14 Jun 2018 002985 RINTI PUSPA SARI abortus iminens + Heg 3 RAWAT 1,282,800
38 10 Jun 2018 13 Jun 2018 013944 FETRIA Heg 2 RAWAT 2,494,100
39 11 Jun 2018 14 Jun 2018 013345 DWI MORA FITRIA bekas SC 2 SC 6,023,900
40 10 Jun 2018 12 Jun 2018 001100 RANTI PUSPITA SARI kontraksi 2 SC 6,023,900
41 11 Jun 2018 13 Jun 2018 013662 NISRA OKTAVIANA kala II memanjang 3 drip + epis + hecting 1,605,500
42 11 Jun 2018 12 Jun 2018 012098 NURHAYATI kpd + preterm 1 DRIP 2,660,400
43 14 Jun 2018 16 Jun 2018 013065 YESI GUSMIATI kpd + anak besar 2 SC 6,023,900
44 15 Jun 2018 20 Jun 2018 010829 MALLINI HELEN kpd 3 drip + epis + hecting 2,256,000
45 15 Jun 2018 17 Jun 2018 005157 RITA FEBRIAN kontraksi + cpd 2 SC 6,023,900
46 16 Jun 2018 18 Jun 2018 013901 LIZA YULIANA inersia uteri + fetal distres + kala II memanjang 2 VE + hecting 2,254,100
47 16 Jun 2018 18 Jun 2018 013713 VIVIN OKTAVIANI kpd 3 lahir spontan + epis + hecting 2,256,000
48 16 Jun 2018 19 Jun 2018 013147 MITA plasenta Previa 3 SC 5,019,900
49 18 Jun 2018 21 Jun 2018 010175 FITRI ROSA bekas SC + Steril 1 SC 7,027,900
50 17 Jun 2018 19 Jun 2018 014052 MISE AGUSTIN inersia uteri 3 dpip + hecting 1,878,400
51 19 Jun 2018 20 Jun 2018 012931 YOLA FITRIANI kontraksi + preterm 3 lahir spontan + hecting 1,878,400
52 17 Jun 2018 20 Jun 2018 001135 SRI PEBRINA DARMIS kontraksi 1 SC 7,027,900
53 19 Jun 2018 22 Jun 2018 000396 ISOM NASRIYAH kontraksi 1 SC 7,027,900
54 18 Jun 2018 19 Jun 2018 013689 LESRI MARIANI letak sungsang 2 drip + lilitan tali pusat 2,254,100
55 18 Jun 2018 19 Jun 2018 010999 DIAN SEPTIANA kpd 2 drip + epis + hecting 2,707,200
56 19 Jun 2018 22 Jun 2018 003877 AMELIA EKA PUTRI letak kepala + letak obliq 2 SC 6,023,900
57 19 Jun 2018 22 Jun 2018 014069 MAYA OKTARINA bekas SC 2 SC 6,023,900
 Tarif
No. Tgl. Masuk Tgl. Pulang No. RM Nama Pasien Diagnosa Kelas Tindakan
BPJS
58 19 Jun 2018 21 Jun 2018 014122 MILA MUSTIKA kpd 3 drip + epis + hecting 2,256,000
59 20 Jun 2018 22 Jun 2018 014086 WENNY SURYA MURTIUS kontraksi 1 SC 7,027,900
60 20 Jun 2018 21 Jun 2018 014127 RILA DARWITA kontraksi + preterm 3 lahir spontan 1,900,300
61 21 Jun 2018 24 Jun 2018 013776 JULI MARLENA kontraksi 3 SC 5,019,900
62 21 Jun 2018 24 Jun 2018 010581 TITIK FERAWATI Kpd + Steril 2 SC 6,023,900
63 21 Jun 2018 24 Jun 2018 005605 SRI RAHMA LIZA bekas SC 1 SC 7,027,900
64 21 Jun 2018 22 Jun 2018 012920 NOVI YARLIS kpd + letsu 3 lahir sungsang 1,878,400
65 21 Jun 2018 24 Jun 2018 009554 MARTA DIYOSA bekas SC 3 SC 5,019,900
66 22 Jun 2018 25 Jun 2018 010610 GUSTAFIANIS Bekas SC 3 SC 5,019,900
67 22 Jun 2018 24 Jun 2018 014191 DEWI SARTIKA SARI letsu + kontraksi 3 SC 5,019,900
68 22 Jun 2018 24 Jun 2018 014012 RETNO ARYANI oligohidramnion + posterm 2 drip + hecting 2,707,200
69 22 Jun 2018 24 Jun 2018 014199 NENI IRMA oligohidramnion 3 drip + hecting 2,256,000
70 22 Jun 2018 24 Jun 2018 011622 RISKA AMELIA kala II memanjang 2 VE + hecting 1,926,700
71 20 Jun 2018 23 Jun 2018 007712 FITRIA EKAWATY bekas SC 1 SC 7,027,900
72 23 Jun 2018 25 Jun 2018 014198 LENNI MARDIAH oligohidramnion 3 DRIP 1,900,300
73 24 Jun 2018 25 Jun 2018 013484 ELFITRA NELI intersia uteri sekunder 3 drip + hecting 1,878,400
74 25 Jun 2018 26 Jun 2018 014250 YUSLIYANTI kpd 3 drip + epis + hecting 2,256,000
75 22 Jun 2018 25 Jun 2018 010850 RAHMADANI bekas SC 2 SC 6,023,900
76 25 Jun 2018 26 Jun 2018 013799 YULIA SARI SUSANTI endomertrium + perdarahan per vaginal 1 CURET 2,411,100
77 25 Jun 2018 28 Jun 2018 013712 NUR ELFADINA bekas SC 3 SC 5,019,900
78 26 Jun 2018 29 Jun 2018 014268 RIKA MEIRIYANTI abortus iminens 2 RAWAT 1,539,300
79 26 Jun 2018 29 Jun 2018 014210 DESI ANDRIANIS bekas SC 3 SC 5,019,900
80 26 Jun 2018 30 Jun 2018 011425 DEWI OKTAVIA kpd + preterm 2 SC 6,023,900
81 26 Jun 2018 30 Jun 2018 014207 YUNI SARA kpd 3 drip + epis + hecting 2,256,000
82 26 Jun 2018 28 Jun 2018 014269 ELIZABETH inersia uteri + postpartum 2 RAWAT 2,494,100
83 27 Jun 2018 29 Jun 2018 011085 YULIZA MELWI bekas SC + Steril 3 SC 5,019,900
84 27 Jun 2018 30 Jun 2018 010254 SHERLY PRAMITA SARI bekas SC 3 SC 5,019,900
85 27 Jun 2018 29 Jun 2018 010320 ZILLA bekas SC 3 SC 5,019,900
86 27 Jun 2018 28 Jun 2018 014290 WINCE DWI FANTA abortus inkomplit 2 CURET 2,066,600
87 27 Jun 2018 30 Jun 2018 013180 DESI SUPRIANTI bekas SC 3 SC 5,019,900
 Tarif
No. Tgl. Masuk Tgl. Pulang No. RM Nama Pasien Diagnosa Kelas Tindakan
BPJS

TOTAL 363,185,800
KAP KLAIM - RSIA SUKMA BUNDA
e Tanggal Pulang: 1 Jun 2018 s/d 30 Jun 2018

Tarif Tambahan
RS Jumlah Ket
3,284,200
6,158,075
2,459,500 2,152,500 307,000 BU
6,775,075 6,108,075 667,000 BU
6,559,375
5,419,700
5,831,375 5,234,375 597,000 BU
3,511,400 3,164,400 347,000
6,095,300
10,265,300 9,433,300 832,000 BU
5,269,650
6,082,950
1,992,875
6,558,075
6,088,375
6,088,075
4,540,275 3,971,775 568,500
5,203,300
2,829,025 2,502,025 327,000
6,544,250 6,122,250 422,000 BU
6,107,375
2,640,775
5,363,475
2,620,275 2,158,275 462,000 BU
1,971,575
3,142,450 2,740,450 402,000
6,034,375
Tarif Tambahan
RS Jumlah Ket
6,790,875
6,536,075
2,825,900
5,299,375
4,031,600 3,349,600 682,000
2,487,700
2,647,150 2,340,150 307,000
2,696,450 2,314,450 382,000
6,391,875
2,299,200
1,750,700
6,038,875
6,134,375
2,672,875 2,365,875 307,000
3,141,275 2,854,275 287,000 BU
6,739,375 6,107,375 632,000 BU
2,076,150
8,647,000
2,906,150
2,932,850 1,961,150 971,700
5,259,375
6,865,375
2,330,275 1,948,275 382,000
2,477,900 2,060,900 417,000
8,894,000 8,027,000 867,000
7,435,800 6,768,800 667,000 BU
2,611,000 2,209,000 402,000
3,189,200 2,787,200 402,000
6,078,300
6,666,375 6,034,375 632,000 BU
Tarif Tambahan
RS Jumlah Ket
2,691,275 2,309,275 382,000
8,613,800
2,328,275 1,946,275 382,000
5,259,375
6,354,000
6,664,375
2,703,200 1,901,200 802,000
8,803,500
5,217,200
5,398,075
3,141,575 2,739,575 402,000 BU
2,660,150 2,278,150 382,000
3,010,275 2,608,275 402,000 BU
10,241,700
2,580,150 2,178,150 402,000
2,628,150 2,246,150 382,000
2,618,150 2,161,150 457,000 BU
7,056,000 6,424,000 632,000 BU
2,757,275
5,239,375
2,493,000
5,272,075
7,441,075
3,095,150 2,307,150 788,000
1,136,000
5,574,375
5,234,075
5,840,375 5,243,375 597,000 BU
2,506,200
6,780,075 6,148,075 632,000 BU
Tarif Tambahan
RS Jumlah Ket
135,206,650 18,911,200
413,628,150
154,117,850
 LAPORAN REKAP KLAIM - RSIA SUKMA BUNDA
Pasien Rawat Inap Periode Tanggal Pulang: 1 Jun 2018 s/d 30 Jun 2018
Tarif
No. Tgl. Masuk Tgl. Pulang No. RM Nama Pasien Diagnosa Kelas Tindakan
BPJS RS
1 31 Mei 2018 2 Jun 2018 013755 BY. NY. DEFI SRI PUTRI undescended testicle + lahir sc 2 3,283,100 632,000
2 31 Mei 2018 2 Jun 2018 013468 BY. NY. WIRA SWASTA kongenital hydrocele + phimosis + lahir sc 1 4,839,800 632,000
3 31 Mei 2018 2 Jun 2018 013765 BY. NY. SRI AULIA NINGSIH lahir SC 3 3,457,000 597,000
4 2 Jun 2018 4 Jun 2018 013792 BY. NY. FEBRINA SYNTIA lahir SC 3 3,457,000 597,000
5 3 Jun 2018 5 Jun 2018 013809 BY. NY. KHAIRANI lahir SC 2 4,148,400 667,000
6 3 Jun 2018 6 Jun 2018 013807 BY. NY. DESI DARMAYANTI ikhterik + lahir SC 2 Fototerapi 4,148,400 857,000
7 4 Jun 2018 6 Jun 2018 013824 BY. NY. FIRLI ROHIMAH lahir SC 2 4,148,400 623,500
8 4 Jun 2018 6 Jun 2018 013826 BY. NY. TIKA SUTRI YENI lahir SC 2 4,148,400 623,500
9 4 Jun 2018 7 Jun 2018 013829 BY. NY. MITRAWATI lahir SC 3 3,457,000 597,000
10 6 Jun 2018 9 Jun 2018 013865 BY. NY. SETRI INDRAWATI lahir SC 3 3,457,000 597,000
11 8 Jun 2018 11 Jun 2018 013894 BY NY DIVA PRAYETA lahir SC 3 3,457,000 632,000
12 9 Jun 2018 11 Jun 2018 013909 BY NY YUSNIVIANTI lahir SC 2 4,148,400 487,000
13 10 Jun 2018 13 Jun 2018 013787 BY. NY. LENI LESTARI undescended testicle + lahir sc 2 3,283,100 632,000
14 9 Jun 2018 11 Jun 2018 013908 BY NY WIDYA RESTI AGUSTIN lahir SC 1 4,839,800 487,000
15 8 Jun 2018 10 Jun 2018 013891 BY NY YULIA SUSWATI BBLR + lahir SC 3 5,185,500 602,000
16 10 Jun 2018 14 Jun 2018 013945 BY. NY. FAUZIAH KURNIA lahir SC 3 3,457,000 682,000
17 10 Jun 2018 12 Jun 2018 013927 BY NY RANTI PUSPITA SARI lahir SC 2 4,148,400 632,000
18 11 Jun 2018 13 Jun 2018 013953 BY. NY. ILMA GUSNETI lahir SC 1 4,839,800 667,000
19 11 Jun 2018 13 Jun 2018 013954 BY NY DWI MORA FITRIA lahir SC 2 4,148,400 632,000
20 17 Jun 2018 21 Jun 2018 014031 BY. NY. VIVIN OKTAVIANI ikhterik + lahir SC 3 Fototerapi 6,222,600 971,700
21 15 Jun 2018 20 Jun 2018 014115 BY. NY. MAILINI HELEN konjungtivitis neonatal + lahir drip 3 1,857,000 948,000
22 16 Jun 2018 18 Jun 2018 014040 BY. NY. MITA lahir SC 3 3,457,000 567,000
23 18 Jun 2018 21 Jun 2018 010175 BY. NY. FITRI ROSA lahir SC 1 4,839,800 697,000
24 16 Jun 2018 18 Jun 2018 014030 BY. NY. LIZA YULIANA lahir ve 2 4,148,400 402,000
25 19 Jun 2018 22 Jun 2018 014095 BY. NY. AMELIA EKA PUTRI lahir SC 2 4,148,400 632,000
26 20 Jun 2018 22 Jun 2018 014087 BY. NY. WENNY SURYA MURTIUS lahir SC 1 4,839,800 697,000
27 21 Jun 2018 24 Jun 2018 014166 BY. NY. JULI MARLENA lahir SC 3 3,457,000 442,000
28 21 Jun 2018 24 Jun 2018 014169 BY. NY. SRI RAHMALIZA lahir SC 1 4,839,800 667,000
 Tarif
No. Tgl. Masuk Tgl. Pulang No. RM Nama Pasien Diagnosa Kelas Tindakan
BPJS RS
29 21 Jun 2018 24 Jun 2018 009554 BY. NY. MARTA DIYOSA lahir SC 3 3,457,000 442,000
30 20 Jun 2018 23 Jun 2018 014133 BY. NY. FITRIA EKAWATY lahir SC 1 4,839,800 707,000
31 21 Jun 2018 24 Jun 2018 014165 BY NY TITIK FERAWATI lahir SC 2 4,148,400 602,000
32 23 Jun 2018 24 Jun 2018 014214 BY NY NENI IRMA cedera pada mata neonatus + lahir drip 3 3,935,200 382,000
33 22 Jun 2018 25 Jun 2018 014195 BY. NY. GUSTAFIANIS lahir SC 3 3,457,000 597,000
34 22 Jun 2018 24 Jun 2018 014192 BY. NY. DEWI SARTIKA SARI lahir SC 3 3,457,000 597,000
35 15 Jun 2018 17 Jun 2018 014014 BY. NY. RITA FEBRIANI lahir SC 2 4,148,400 727,000
36 25 Jun 2018 28 Jun 2018 014252 BY. NY. NUR ELFADINA lahir SC 3 3,457,000 597,000
37 26 Jun 2018 29 Jun 2018 014270 BY. NY. DESI ANDRIANIS lahir SC 3 3,457,000 597,000
38 27 Jun 2018 29 Jun 2018 014289 BY. NY. YULIZA MELWI lahir SC 3 3,457,000 632,000
39 27 Jun 2018 30 Jun 2018 014292 BY. NY. SHERLY PRAMITA SARI infeksi neonatus + lahir sc 3 1,857,000 597,000
40 27 Jun 2018 30 Jun 2018 014295 BY NY DEWI OKTAVIA lahir SC 2 4,148,400 667,000
TOTAL 157,680,900 25,043,700
 LAPORAN REKAP KLAIM - RSIA SUKMA BUNDA
Pasien Rawat Inap Periode Tanggal Pulang: 1 Jun 2018 s/d 30 Jun 2018
Filter: Metode Pembayaran = Semua / Kelas Rawat = Semua / Severity = Semua / Cara Pulang = Semua / Jenis Tarif = TARIF RS KELAS C SWASTA
Tarif
No. Tgl. Masuk Tgl. Pulang No. RM Nama Pasien Diagnosa Kelas Tindakan
BPJS RS
1 4 Jun 2018 6 Jun 2018 013558 RAFARDHAN ZAYN ATHAYLAH FEBRIS 2 3,149,400 1,760,000
2 3 Jun 2018 7 Jun 2018 013810 ADIBA FARZANA GEA 1 3,674,300 3,253,000
3 18 Jun 2018 20 Jun 2018 007725 KAL GHANI YUKI GEA 2 1,753,800 230,000
4 19 Jun 2018 22 Jun 2018 014095 BY. NY. AMELIA EKA PUTRI IKHTERIK 2 4,148,400 632,000
5 20 Jun 2018 22 Jun 2018 007451 RAIHAN PUTRA RENDRA GEA 1 2,798,400 1,572,000
6 20 Jun 2018 26 Jun 2018 014153 ADEEVA AFSHEEN GENEFRI GEA 2 1,753,800 3,430,500
7 20 Jun 2018 24 Jun 2018 014154 AGAM SAMBARA EL GENEFRI GEA 2 1,753,800 2,485,000
8 23 Jun 2018 26 Jun 2018 013626 MUHAMMAD GIFARI AZKA KEJANG DEMAM 1 3,307,900 2,384,000
9 24 Jun 2018 30 Jun 2018 013703 RAISSA PUTRI IMTYAS TONSILOFARINGITIS 2 2,685,200 1,750,700
10 22 Jun 2018 25 Jun 2018 014195 BY. NY. GUSTAFIANIS LAHIR SC 3 3,457,000 597,000
11 25 Jun 2018 28 Jun 2018 014260 ADIFA DWI PUTRI GEA 3 1,461,500 1,342,500
12 26 Jun 2018 27 Jun 2018 014285 KEZIA RIMBUN PUTRI SITORUS TONSILOFARINGITIS 2 2,685,200 998,000
13 27 Jun 2018 29 Jun 2018 014095 BY. NY. AMELIA EKA PUTRI IKHTERIK 2 Fototerapi 3,893,600 760,000
TOTAL 36,522,300 21,194,700