Kantor Regional BPJS : VII KC Mojokerto

Provinsi : Jawa Timur

Kabupaten/Kota : Mojokerto
Nama RS : RS Gatoel

PENGAJUAN KLAIM

No TANGGAL
JUMLAH
BULAN TAGIHAN DITERIMA JUMLAH KASUS BIAYA (Rp)
PASIEN
PENGAJUAN

1 2 3 4 5 6

1 SEBELUM 2018*
2 JANUARI 2018 1/9/2018 12 12 6,087,750
3 FEBRUARI 2018 2/1/2018 10 10 4,258,750
4 MARET 2018 3/16/2018 16 16 6,405,250
5 APRIL 2018 4/20/2018 9 9 2,618,085
6 MEI 2018 5/16/2018 14 14 4,530,250
7 JUNI 2018 6/6/2018 15 15 6,061,400
8 JULI 2018 7/10/2018 15 15 4,303,680
9 AGUSTUS 2018 8/16/2018 13 13 4,382,000
10 SEPTEMBER 2018 9/12/2018 10 10 3,440,000
11 OKTOBER 2018 10/24/2018 9 9 3,090,000
12 NOVEMBER 2018 11/22/2018 17 17 6,497,400
13 DESEMBER 2018 10/12/2018 18 18 6,732,200
12/31/2018 18 18 6,129,800

JUMLAH

BULAN LAYANAN TANGGAL DIBAYAR JUMLAH DIBAYAR

Jul-17 3/9/2018 244,991,072 inti
3/19/2018 256,551,186 inti
2017 5/16/2018 484,640,909 obat 2017
9/4/2018 8,347,300 Obat RITL 2017
9/17/2018 237,499,874 Obat RJTL 2017
 BIAYA MANFAAT YANG SUDAH DIKLAIM RUMAH S

KLAIM DISETUJUI KLAIM PENDING KLAIM D

TANGGAL
BA BERKAS TANGGAL JUMLAH JUMLAH JUMLA JUMLA
JUMLAH
LENGKAP DISETUJUI PASIEN KASUS BIAYA (Rp) H BIAYA (Rp) H
PASIEN
KASUS PASIEN

7 8 9 10 11 12 13 14 15

12 12 6,087,750 - - - -
10 10 4,258,750 - - - -
16 16 6,405,250 - - - -
5/3/2018 9 9 2,618,085 - - - -
6/4/2018 14 14 4,530,250 - - - -
7/4/2018 15 15 6,061,400 - - - -
7/24/2018 15 15 4,303,680 - - - -
8/30/2018 13 13 4,382,000 - - - -
9/28/2018 10 10 3,440,000 - - - -
10/31/2018 9 9 3,090,000 - - - -
11/29/2018 17 17 6,497,400 - - - -
12/18/2018 18 18 6,732,200 - - - -
- - - -
AIM RUMAH SAKIT ALKES DAN AMBULANS

KLAIM DISPUTE KLAIM TIDAK LAYAK BAYAR SUDAH DIBAYAR

JUMLA JUMLA JUMLA
TANGGAL
H BIAYA (Rp) H H BIAYA (Rp) JUMLAH (Rp)
DIBAYAR
KASUS PASIEN KASUS

16 17 18 19 20 21 22

- - - - - 2/21/2018 6,077,750 10,000

- - - - - 3/7/2018 4,253,750 5,000
- - - - - 4/16/2018 6,395,250 10,000
- - - - - 5/17/2018 2,243,085 375,000
- - - - - 6/28/2018 4,520,250 10,000
- - - - - 8/2/2018 6,051,400 10,000
- - - - - 9/4/2018 4,293,680 10,000
- - - - - 10/4/2018 4,372,000 10,000
- - - - - 11/5/2018 3,430,000 10,000
- - - - - 12/18/2018 3,080,000 10,000
- - - - - 6,497,400
- - - - - 6,732,200
- - - - - -
-
 \ Lampiran 6.3

HASIL PENGUJIAN KLAIM**

Nilai Uji KLAIM KLAIM KLAIM KLAIM LAIN-
Jumlah Kasus JUMLAH
Petik GANDA FIKTIF MISREADING UPCODING LAIN
yang diuji petik (Rp)
(Rp) (Rp) (Rp) (Rp) (Rp) (Rp)
30 = (25+ 26
23 24 25 26 27 28 29 +27 +
28+29)
n 6.3

KETEPATAN WAKTU***
BA
LENGKA DIBAYAR
P

30 31
 RUDI HARYANTO 087810357350/alamat email rudibpkp@gmail.com
TRI MARHENIWATI 081232252266
SINUNG SAKSONO 081803387496

NAMA RS :
ALAMAT :
PIMPINAN RS :
TYPE RS :
BULAN MENERAPKAN VEDIKA : EFEKTIF/TIDAK EFEKTIF
MEMANFAATKAN SCF : YA/TIDAK
NILAI PINJAMAN ;
SALDO PER 31/12-2018 : NAMA BANK

PENGAJUAN KLAIM BERKAS LENGKAP KLAIM DISETUJUI KLAIM PENDING KLAIM DISPUTE KLAIM TIDAK LAYAK BAYAR SUDAH DIBAYAR
TANGGAL TANGGAL BA TANGGAL BA JUMLA TANGGA
No JENIS JUMLAH JUMLAH JUMLAH JUMLAH JUMLAH JUMLAH JUMLAH JUMLAH JUMLAH
BULAN TAGIHAN DITERIMA PENERIMAAN BIAYA (Rp) HASIL KLAIM BIAYA (Rp) BIAYA (Rp) BIAYA (Rp) H BIAYA (Rp) L JUMLAH (Rp)
PELAYANAN PASIEN KASUS PASIEN KASUS PASIEN KASUS PASIEN KASUS PASIEN
PENGAJUAN BERKAS KASUS DIBAYAR
1 2 3 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22

1 SEBELUM 2018*

Inti Desember 2017 Rawat Jalan 1/4/2018 1/29/2018 1613 1613 283,310,200 1/29/2018 1566 1566 46 46 10,330,400 0 0 0 0 - 321,679,500

Rawat Inap 1/4/2018 1/29/2018 256 256 701,321,300 1/29/2018 237 237 19 19 59,971,300 0 0 0 0 0 2/27/2018 913,642,400

Susulan (1) Rawat Jalan 1/4/2018 1/29/2018 90 90 16,764,500 2/8/2018 89 89 1 1 185,000 0 0 0 0 0 0 2/6/2918 4,261,600

Rawat Inap 1/4/2018 1/29/2018 19 19 46,823,700 2/8/2018 17 17 1 1 5,797,800 0 0 0 0 0 0 2/27/2018 61,770,200

Susulan (2) Rawat Jalan 3/2/2018 3/2/2018 47 47 9,198,400 6/19/2018 25 25 0 0 0 0 0 0 0 0 0 2/27/2018 5,640,600

Rawat Inap 3/2/2018 3/2/2018 20 20 52,484,400 3/2/2018 0 0 0 0 0 0 0 0 0 0 0 0

2 JANUARI 2018

Inti Rawat Jalan 3/5/2018 3/5/2018 1874 1874 332,972,100 3/14/2018 1813 1813 321,679,500 48 48 8,956,000 0 0 0 13 13 2,336,600 321,679,500

Rawat Inap 3/5/2018 3/5/2018 345 345 985,026,200 3/14/2018 327 327 913,642,400 18 18 71,383,800 0 0 0 0 0 0 913,642,400

Susulan (1) Rawat Jalan 5/28/2018 5/28/2018 48 48 8,774,900 5/31/2018 24 24 4,261,600 22 22 4,143,300 0 0 0 0 0 0 4,261,600

Rawat Inap 5/28/2018 5/28/2018 18 18 67,568,000 5/31/2018 17 17 61,770,200 1 1 5,797,800 0 0 0 0 0 0 61,770,200

Susulan (2) Rawat Jalan 6/19/2018 6/8/2018 25 25 5,640,600 6/19/2018 25 25 5,640,600 0 0 0 0 0 0 0 0 0 5,640,600

Rawat Inap 6/19/2018 6/8/2018 0 0 - 0 0 0 0 0 0 0 0 0 0 0 0 0 0

3 FEBRUARI 2018

Inti Rawat Jalan 4/2/2018 4/2/2018 1709 1709 296,721,500 4/16/2018 1677 1677 290,477,400 27 27 5,492,800 0 0 0 0 0 0 20-Apr
963,714,900
Rawat Inap 4/2/2018 4/2/2018 280 280 797,759,300 4/16/2018 246 246 679,438,100 34 34 118,321,200 0 0 0 0 0 0

Susulan (1) Rawat Jalan 23/7/2018 23/7/2018 27 27 6,656,300 3/8/2018 16 16 4,570,700 11 11 2,085,600 0 0 0 0 0 0 4-Sep
81,317,300
Rawat Inap 23/7/2018 23/7/2018 34 34 87,224,600 3/8/2018 31 31 76,746,600 3 3 10,478,000 0 0 0 0 0 0

Susulan (2) Rawat Jalan 12/10/2018 16/10/2018 13 13 5,785,700 16/10/2018 13 13 5,785,700 0 0 0 0 0 0 0 0 0

7,120,100
Rawat Inap 12/10/2018 16/10/2018 1 1 1,334,400 16/10/2018 1 1 1,334,400 0 0 0 0 0 0 0 0 0

4 MARET 2018

Inti Rawat Jalan 3/5/2018 3/5/2018 2089 2089 369,092,600 3/5/2018 2065 2065 364,303,700 18 18 3,678,600 0 0 0 0 0 0 28-May
1,101,150,000
Rawat Inap 3/5/2018 3/5/2018 316 316 811,258,800 3/5/2018 296 296 736,846,300 16 16 57,927,600 0 0 0 0 0 0

Susulan (1) Rawat Jalan 11/10/2018 11/10/2018 18 18 3,678,600 12/10/2018 18 18 3,678,600 0 0 0 3,678,600

Rawat Inap 11/10/2018 11/10/2018 20 20 67,520,600 12/10/2018 20 20 67,520,600 0 0 0 67,520,600

5 APRIL 2018

Inti Rawat Jalan 31/05/2018 31/05/2018 2180 2180 387,907,200 25/06/2018 1099 1099 187,356,300 1076 1076 199,521,200 0 0 0 3 3 549,200 187,356,300

Rawat Inap 31/05/2018 31/05/2018 330 330 948,460,300 25/06/2018 317 317 903,034,800 12 12 42,821,700 0 0 0 0 0 0 903,034,800

Susulan (1) Rawat Jalan 31/12/2018 31/12/2018 1077 1077 196,537,400 16/12/2018 1072 1072 195,612,400 5 5 925,000 0 0 0 0 0 0 195,612,400

Rawat Inap 31/12/2018 31/12/2018 13 13 34,008,700 16/12/2018 13 13 34,008,700 0 0 0 0 0 0 0 0 0 34,008,700

Susulan (2) Rawat Jalan 19/12/2018 19/12/2018 5 5 810,300 19/12/2018 5 5 810,300 0 0 0 0 0 0 0 0 0 810,300

6 MEI 2018

Inti Rawat Jalan 4/7/2018 4/7/2018 2040 2040 357,611,200 18/07/2018 1869 1869 325,042,600 171 171 32,568,600 0 0 0 0 0 0 325,042,600

Rawat Inap 4/7/2018 4/7/2018 325 325 1,033,361,200 18/07/2018 288 288 886,736,800 37 37 141,442,800 0 0 0 0 0 0 886,736,800

Susulan (1) Rawat Jalan 2/11/2018 2/11/2018 171 171 31,610,700 10/11/2018 168 168 31,090,600 2 2 520,100 0 0 0 0 0 0 31,090,600

Rawat Inap 2/11/2018 2/11/2018 39 39 31,610,700 10/11/2018 31 31 88,912,000 7 7 28,892,900 0 0 0 0 0 0 89,859,579

Susulan (2) Rawat Jalan 22/11/2018 22/11/2018 2 2 520,100 22/11/2018 2 2 520,100 0 0 0 0 0 0 0 0 0 520,100

Rawat Inap 22/11/2018 22/11/2018 7 7 28,775,900 22/11/2018 7 7 28,775,900 0 0 0 0 0 0 0 0 0 28,775,900

7 JUNI 2018

Inti Rawat Jalan 1/8/2018 1/8/2018 1702 1702 302,695,600 14/8/2018 1653 1653 293,192,700 49 49 9,502,900 2 2 307,900 0 0 0 293,192,700

Rawat Inap 1/8/2018 1/8/2018 221 221 560,758,000 14/8/2018 194 194 472,771,900 27 27 87,986,900 0 0 0 0 0 0 472,771,900

8 JULI 2018

Inti Rawat Jalan 7/9/2018 7/9/2018 1995 1995 355,318,600 20/9/2018 1973 1973 351,276,100 12 12 2,306,700 2 2 367,100 7 7 1,183,700 351,276,100

Rawat Inap 7/9/2018 7/9/2018 255 255 754,866,700 20/9/2018 228 228 662,992,100 24 24 67,349,300 2 2 20,397,100 0 0 0 662,992,100

9 AGUSTUS 2018

Inti Rawat Jalan 25/9/2018 25/9/2018 1841 1841 327,912,900 4/10/2018 1803 1803 320,250,000 31 31 6,310,200 0 0 0 2 2 439,300 320,250,000

Rawat Inap 25/9/2018 25/9/2018 268 268 766,052,000 4/10/2018 213 213 595,329,700 51 51 161,983,500 0 0 0 0 0 0 595,329,700

10 SEPTEMBER 2018

Inti Rawat Jalan 31/10/2018 31/10/2018 1820 1820 324,230,400 7/11/2018 1805 1805 321,082,000 14 14 2,963,400 0 0 0 1 1 185,000 321,082,000

Rawat Inap 31/10/2018 31/10/2018 275 275 779,733,900 7/11/2018 229 229 586,628,400 45 45 191,926,800 0 0 0 0 0 0 586,628,400

Susulan (1) Rawat Jalan 30/10/2018 30/10/2018 14 14 2,530,900 4/12/2018 4 4 686,800 35 35 136,484,200 0 0 0 0 0 0 686,800

Rawat Inap 30/10/2018 30/10/2018 45 45 176,394,800 4/12/2018 10 10 27,515,800 10 10 37,537,600 0 0 0 0 0 0 136,484,200

Susulan (2) Rawat Jalan 6/2/2019 6/2/2019 7 7 1,292,100 6/2/2019 7 7 1,292,100 3 3 546,300 0 0 0 0 0 0 1,292,100

Rawat Inap 6/2/2019 6/2/2019 7 7 18,118,400 6/2/2019 5 5 11,372,700 5 5 26,511,300 0 0 0 0 0 0 11,372,700

11 OKTOBER 2018

Inti Rawat Jalan 7/12/2018 7/12/2018 2608 2608 466,623,200 14/12/2018 2572 2572 457,992,300 37 37 8,815,900 0 0 0 0 0 0 457,992,300

Rawat Inap 7/12/2018 7/12/2018 336 336 954,390,500 14/12/2019 316 316 891,958,200 22 22 74,054,700 0 0 0 0 0 0 891,958,200

Susulan (1) Rawat Jalan 8/2/2019 8/2/2019 36 36 8,444,200 14/2/2019 30 30 6,539,700 6 6 1,904,500 0 0 0 0 0 0 6,539,700

9 9 23,367,000

Rawat Inap 8/2/2019 8/2/2019 22 22 73,971,500 14/2/2019 13 13 36,065,200 9 9 37,906,300 0 0 0 0 0 0 36,065,200

12 NOVEMBER 2018

Inti Rawat Jalan 17/01/2019 17/01/2019 2527 2527 450,840,200 22/01/2019 2498 2498 442,912,700 23 23 6,758,300 0 0 0 2 2 432,100 442,912,700

Rawat Inap 17/01/2019 17/01/2019 324 324 927,463,500 22/01/2019 268 268 740,076,700 55 55 186,274,800 0 0 0 0 0 0 740,076,700

13 DESEMBER 2018

Inti Rawat Jalan 31/01/2019 31/01/2019 2510 2510 443,666,300 15/02/2019 2457 2457 431,946,200 53 53 11,720,100 0 0 0 0 0 0 431,946,200

Rawat Inap 31/01/2019 31/01/2019 377 377 1,093,988,400 15/02/2019 322 322 886,139,800 54 54 189,767,400 1 1 5,329,500 0 0 0 886,139,800

JUMLAH 13,780,985,000 4,261,600

13781531300

DATA YANG DIPERLUKAN :

FC/PDF BA PENERIMAAN BERKAS
FC/Scan PDF BA HASIL VERIIKASI
LAPORAN REKAP KLAIM RI dan RJ Per Bulan (Excel)
LAYANAN RI DAN RJ YANG BELUM DIKLAIMKAN
LAYANAN NON RI DAN RJ YANG SUDAH DI KLAIM KAN
LAYANAN NON RI DAN RJ YANG BELUM KLAIM KAN
 RUDI HARYANTO 087810357350/alamat email rudibpkp@gmail.com
TRI MARHENIWATI 081232252266
SINUNG SAKSONO 081803387496

NAMA RS :
ALAMAT :
PIMPINAN RS :
TYPE RS :
BULAN MENERAPKAN VEDIKA : EFEKTIF/TIDAK EFEKTIF
MEMANFAATKAN SCF : YA/TIDAK
NILAI PINJAMAN ;
SALDO PER 31/12-2018 : NAMA BANK

PENGAJUAN KLAIM BERKAS LENGKAP KLAIM DISETUJUI KLAIM PENDING KLAIM DISPUTE KLAIM TIDAK LAYAK BAYAR SUDAH DIBAYAR
TANGGAL TANGGAL BA TANGGAL BA JUMLA
No JENIS JUMLAH JUMLAH JUMLAH JUMLAH JUMLAH JUMLAH JUMLAH JUMLAH JUMLAH TANGGAL
BULAN TAGIHAN DITERIMA PENERIMAAN BIAYA (Rp) HASIL KLAIM BIAYA (Rp) BIAYA (Rp) BIAYA (Rp) H BIAYA (Rp) JUMLAH (Rp)
PELAYANAN PASIEN KASUS PASIEN KASUS PASIEN KASUS PASIEN KASUS PASIEN DIBAYAR
PENGAJUAN BERKAS KASUS
1 2 3 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22

1 SEBELUM 2018*

Inti Desember 2017 Rawat Jalan 1/4/2018 1/29/2018 1613 1613 283,310,200 1/29/2018 1566 1566 272,612,700 46 46 10,330,400 0 0 0 0 - 321,679,500

Rawat Inap 1/4/2018 1/29/2018 256 256 701,321,300 1/29/2018 237 237 641,350,000 19 19 59,971,300 0 0 0 0 0 2/27/2018 913,642,400

Susulan (1) Rawat Jalan 1/4/2018 1/29/2018 90 90 16,764,500 2/8/2018 89 89 16,205,500 1 1 185,000 0 0 0 0 0 0 2/6/2918 4,261,600

Rawat Inap 1/4/2018 1/29/2018 19 19 46,823,700 2/8/2018 17 17 61,770,200 1 1 5,797,800 0 0 0 0 0 0 2/27/2018 61,770,200

Susulan (2) Rawat Jalan 3/2/2018 3/2/2018 47 47 9,198,400 6/19/2018 25 25 5,640,600 0 0 0 0 0 0 0 0 0 2/27/2018 5,640,600

Rawat Inap 3/2/2018 3/2/2018 20 20 52,484,400 3/2/2018 0 0 0 0 0 0 0 0 0 0 0 0 0

2 JANUARI 2018

Inti Rawat Jalan 3/5/2018 3/5/2018 1874 1874 332,972,100 3/14/2018 1813 1813 321,679,500 48 48 8,956,000 0 0 0 13 13 2,336,600 321,679,500

Rawat Inap 3/5/2018 3/5/2018 345 345 985,026,200 3/14/2018 327 327 913,642,400 18 18 71,383,800 0 0 0 0 0 0 913,642,400

Susulan (1) Rawat Jalan 5/28/2018 5/28/2018 48 48 8,774,900 5/31/2018 24 24 4,261,600 22 22 4,143,300 0 0 0 0 0 0 4,261,600

Rawat Inap 5/28/2018 5/28/2018 18 18 67,568,000 5/31/2018 17 17 61,770,200 1 1 5,797,800 0 0 0 0 0 0 61,770,200

Susulan (2) Rawat Jalan 6/19/2018 6/8/2018 25 25 5,640,600 6/19/2018 25 25 5,640,600 0 0 0 0 0 0 0 0 0 5,640,600

Rawat Inap 6/19/2018 6/8/2018 0 0 - 0 0 0 0 0 0 0 0 0 0 0 0 0 0

3 FEBRUARI 2018

Inti Rawat Jalan 4/2/2018 4/2/2018 1709 1709 296,721,500 4/16/2018 1677 1677 290,477,400 27 27 5,492,800 0 0 0 0 0 0 20-Apr
963,714,900
Rawat Inap 4/2/2018 4/2/2018 280 280 797,759,300 4/16/2018 246 246 679,438,100 34 34 118,321,200 0 0 0 0 0 0

Susulan (1) Rawat Jalan 23/7/2018 23/7/2018 27 27 6,656,300 3/8/2018 16 16 4,570,700 11 11 2,085,600 0 0 0 0 0 0 4-Sep
81,317,300
Rawat Inap 23/7/2018 23/7/2018 34 34 87,224,600 3/8/2018 31 31 76,746,600 3 3 10,478,000 0 0 0 0 0 0

Susulan (2) Rawat Jalan 12/10/2018 16/10/2018 13 13 5,785,700 16/10/2018 13 13 5,785,700 0 0 0 0 0 0 0 0 0

7,120,100
Rawat Inap 12/10/2018 16/10/2018 1 1 1,334,400 16/10/2018 1 1 1,334,400 0 0 0 0 0 0 0 0 0

4 MARET 2018

Inti Rawat Jalan 3/5/2018 3/5/2018 2089 2089 369,092,600 3/5/2018 2065 2065 364,303,700 18 18 3,678,600 0 0 0 0 0 0 28-May
1,101,150,000
Rawat Inap 3/5/2018 3/5/2018 316 316 811,258,800 3/5/2018 296 296 736,846,300 16 16 57,927,600 0 0 0 0 0 0

Susulan (1) Rawat Jalan 11/10/2018 11/10/2018 18 18 3,678,600 12/10/2018 18 18 3,678,600 0 0 0 3,678,600

Rawat Inap 11/10/2018 11/10/2018 20 20 67,520,600 12/10/2018 20 20 67,520,600 0 0 0 67,520,600

5 APRIL 2018

Inti Rawat Jalan 31/05/2018 31/05/2018 2180 2180 387,907,200 25/06/2018 1099 1099 187,356,300 1076 1076 199,521,200 0 0 0 3 3 549,200 187,356,300

Rawat Inap 31/05/2018 31/05/2018 330 330 948,460,300 25/06/2018 1076 1076 199,521,200 12 12 42,821,700 0 0 0 0 0 0 903,034,800

Susulan (1) Rawat Jalan 31/12/2018 31/12/2018 1077 1077 196,537,400 16/12/2018 1072 1072 195,612,400 5 5 925,000 0 0 0 0 0 0 195,612,400

Rawat Inap 31/12/2018 31/12/2018 13 13 34,008,700 16/12/2018 13 13 34,008,700 0 0 0 0 0 0 0 0 0 34,008,700

Susulan (2) Rawat Jalan 19/12/2018 19/12/2018 5 5 810,300 19/12/2018 5 5 810,300 0 0 0 0 0 0 0 0 0 810,300

6 MEI 2018

Inti Rawat Jalan 4/7/2018 4/7/2018 2040 2040 357,611,200 18/07/2018 1869 1869 325,042,600 171 171 32,568,600 0 0 0 0 0 0 325,042,600

Rawat Inap 4/7/2018 4/7/2018 325 325 1,033,361,200 18/07/2018 288 288 886,736,800 37 37 141,442,800 0 0 0 0 0 0 886,736,800

Susulan (1) Rawat Jalan 2/11/2018 2/11/2018 171 171 31,610,700 10/11/2018 168 168 30,908,500 2 2 520,100 0 0 0 0 0 0 31,090,600

Rawat Inap 2/11/2018 2/11/2018 39 39 31,610,700 10/11/2018 31 31 81,450,600 7 7 28,892,900 0 0 0 0 0 0 89,859,579

Susulan (2) Rawat Jalan 22/11/2018 22/11/2018 2 2 520,100 22/11/2018 2 2 520,100 0 0 0 0 0 0 0 0 0 520,100

Rawat Inap 22/11/2018 22/11/2018 7 7 28,775,900 22/11/2018 7 7 28,775,900 0 0 0 0 0 0 0 0 0 28,775,900

7 JUNI 2018

Inti Rawat Jalan 1/8/2018 1/8/2018 1702 1702 302,695,600 14/8/2018 1653 1653 293,192,700 49 49 9,502,900 2 2 307,900 0 0 0 293,192,700

Rawat Inap 1/8/2018 1/8/2018 221 221 560,758,000 14/8/2018 194 194 472,771,900 27 27 87,986,900 0 0 0 0 0 0 472,771,900

8 JULI 2018

Inti Rawat Jalan 7/9/2018 7/9/2018 1995 1995 355,318,600 20/9/2018 1973 1973 351,276,100 12 12 2,306,700 2 2 367,100 7 7 1,183,700 351,276,100

Rawat Inap 7/9/2018 7/9/2018 255 255 754,866,700 20/9/2018 228 228 662,992,100 24 24 67,349,300 2 2 20,397,100 0 0 0 662,992,100

9 AGUSTUS 2018

Inti Rawat Jalan 25/9/2018 25/9/2018 1841 1841 327,912,900 4/10/2018 1803 1803 320,250,000 31 31 6,310,200 0 0 0 2 2 439,300 320,250,000

Rawat Inap 25/9/2018 25/9/2018 268 268 766,052,000 4/10/2018 213 213 595,329,700 51 51 161,983,500 0 0 0 0 0 0 595,329,700

10 SEPTEMBER 2018

Inti Rawat Jalan 31/10/2018 31/10/2018 1820 1820 324,230,400 7/11/2018 1805 1805 321,082,000 14 14 2,963,400 0 0 0 1 1 185,000 321,082,000

Rawat Inap 31/10/2018 31/10/2018 275 275 779,733,900 7/11/2018 229 229 586,628,400 45 45 191,926,800 0 0 0 0 0 0 586,628,400

Susulan (1) Rawat Jalan 30/10/2018 30/10/2018 14 14 2,530,900 4/12/2018 4 4 686,800 35 35 136,484,200 0 0 0 0 0 0 686,800

Rawat Inap 30/10/2018 30/10/2018 45 45 176,394,800 4/12/2018 10 10 1,844,100 10 10 37,537,600 0 0 0 0 0 0 136,484,200

Susulan (2) Rawat Jalan 6/2/2019 6/2/2019 7 7 1,292,100 6/2/2019 7 7 1,292,100 3 3 546,300 0 0 0 0 0 0 1,292,100

Rawat Inap 6/2/2019 6/2/2019 7 7 18,118,400 6/2/2019 5 5 11,372,700 5 5 26,511,300 0 0 0 0 0 0 11,372,700

11 OKTOBER 2018

Inti Rawat Jalan 7/12/2018 7/12/2018 2608 2608 466,623,200 14/12/2018 2572 2572 457,992,300 37 37 8,815,900 0 0 0 0 0 0 457,992,300

Rawat Inap 7/12/2018 7/12/2018 336 336 954,390,500 14/12/2019 316 316 891,958,200 22 22 74,054,700 0 0 0 0 0 0 891,958,200

Susulan (1) Rawat Jalan 8/2/2019 8/2/2019 36 36 8,444,200 14/2/2019 30 30 6,539,700 6 6 1,904,500 0 0 0 0 0 0 6,539,700

Rawat Inap 8/2/2019 8/2/2019 22 22 73,971,500 14/2/2019 13 13 36,065,200 9 9 37,906,300 0 0 0 0 0 0 36,065,200

12 NOVEMBER 2018

Inti Rawat Jalan 17/01/2019 17/01/2019 2527 2527 450,840,200 22/01/2019 2498 2498 442,912,700 23 23 6,758,300 0 0 0 2 2 432,100 442,912,700

Rawat Inap 17/01/2019 17/01/2019 324 324 927,463,500 22/01/2019 268 268 740,076,700 55 55 186,274,800 0 0 0 0 0 0 740,076,700

13 DESEMBER 2018

Inti Rawat Jalan 31/01/2019 31/01/2019 2510 2510 443,666,300 15/02/2019 2457 2457 431,946,200 53 53 11,720,100 0 0 0 0 0 0 431,946,200

Rawat Inap 31/01/2019 31/01/2019 377 377 1,093,988,400 15/02/2019 322 322 886,139,800 54 54 189,767,400 1 1 5,329,500 0 0 0 886,139,800

JUMLAH 14,018,368,200 #VALUE!

DATA YANG DIPERLUKAN :

FC/PDF BA PENERIMAAN BERKAS
FC/Scan PDF BA HASIL VERIIKASI
LAPORAN REKAP KLAIM RI dan RJ Per Bulan (Excel)
LAYANAN RI DAN RJ YANG BELUM DIKLAIMKAN
LAYANAN NON RI DAN RJ YANG SUDAH DI KLAIM KAN
LAYANAN NON RI DAN RJ YANG BELUM KLAIM KAN
NON LAYANAN

PENGAJUAN KLAIM BERKAS LENGKAP KLAIM DISETUJUI KLAIM PENDING KLAIM DISPUTE KLAIM TIDAK LAYAK BAYAR SUDAH DIBAYAR
TANGGAL TANGGAL BA TANGGAL BA JUMLA TANGGA
No JENIS JUMLAH JUMLAH
BULAN TAGIHAN DITERIMA PENERIMAAN BIAYA (Rp) HASIL KLAIM JUMLAH JUMLAH BIAYA (Rp) JUMLAH JUMLAH BIAYA JUMLAH JUMLAH BIAYA JUMLAH
H
BIAYA
L JUMLAH (Rp)
PELAYANAN PASIEN KASUS PASIEN KASUS PASIEN KASUS (Rp) PASIEN KASUS (Rp) PASIEN (Rp)
PENGAJUAN BERKAS KASUS DIBAYAR
1 2 3 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22

1 SEBELUM 2018*

2 JANUARI 2018 Obat 31-01-2018 31-01-2018 265 365 30,503,808 31-01-2018 265 365 30,503,808 . 30,503,808

Ambulance

Alat Kesehatan

Dll

3 FEBRUARI 2018 Obat 28-02-2018 28-02-2018 274 274 29,018,138 28-02-2018 274 274 29,018,138 29,018,138

Ambulance

Alat Kesehatan

Dll

4 MARET 2018 Obat 31-03-2018 31-03-2018 268 268 28,719,289 31-03-2018 268 268 28,719,289 28,719,289

Ambulance

Alat Kesehatan

Dll

5 APRIL 2018 Obat

Ambulance

Alat Kesehatan

Dll

6 MEI 2018 Obat

Ambulance

Alat Kesehatan

Dll

7 JUNI 2018 Obat

Ambulance

Alat Kesehatan

Dll

8 JULI 2018 Obat

Ambulance

Alat Kesehatan

Dll

9 AGUSTUS 2018 Obat 22-02-2019 22-02-2019 213 213 27,138,322 22-02-2019 213 213 26,987,000 26,978,000

Obat Susulan 1 22-02-2019 22-02-2019 54 54 481,402 22-02-2019 54 54 481,402 481,402

Alat Kesehatan

Dll

10 SEPTEMBER 2018 Obat 22-02-2019 22-02-2019 284 284 36,574,645 22-02-2019 284 284 36,574,645 36,574,645

Alat Kesehatan 31-10-2018 31-10-2018 1 1 350,000 7/11/2018 1 1 350,000 350,000

Obat Susulan 1 22-02-2019 22-02-2019 70 70 573,227 22-02-2019 70 70 573,227 573,227

11 OKTOBER 2018 Obat 22-02-2019 22-02-2019 357 357 44,202,645 22-02-2019 357 357 44,097,708 44,097,708

Alat Kesehatan

Dll

12 NOVEMBER 2018 Obat 22-02-2019 22-02-2019 378 378 51,517,868 22-02-2019 378 378 51,517,868 51,517,868

Alat Kesehatan

Dll

13 DESEMBER 2018 Obat 22-02-2019 22-02-2019 365 365 54,415,887 22-02-2019 365 365 54,306,267 54,306,267

Ambulance

Alat Kesehatan

Dll

JUMLAH