BPJS Kesehatan Cab.

PALU
UMPAN BALIK VERIFIKASI
PENGAJUAN KLAIM TINGKAT PERTAMA

Nomor FPK : P2202000020074

Provider : TINOMBO

Bulan Pelayanan : February 2022

Pelayanan : RITP

Pelayanan Verifikasi

Total Data : 13 Total Data : 13 Layak : 13 Tidak Layak : 0

Total Tagihan : Rp. 7.300.000 Total Tagihan : Rp. 7.300.000 Pending : 0 DIspute : 0

NO TRANSAKSI NAMA PESERTA TGL MASUK TGL PULANG BIAYA STAT KETERANGAN

200902010222P000070 ANIFA (0000135739833) 02/02/2022 05/02/2022 Rp. 540.000 Layak

200902010222P000071 HARJUN (0000134712988) 06/02/2022 09/02/2022 Rp. 540.000 Layak

200902010222P000209 HIDAYAT LAKORO (0000134803045) 10/02/2022 13/02/2022 Rp. 540.000 Layak

200902010222P000210 MOHAMMAD FAZAL (0000917923318) 05/02/2022 08/02/2022 Rp. 540.000 Layak

200902010222P000224 RISMAWATI (0002390482844) 15/02/2022 16/02/2022 Rp. 700.000 Layak

200902010222P000225 ALANG (0000918765832) 25/02/2022 26/02/2022 Rp. 700.000 Layak

200902010222P000226 SAKINA (0000918853457) 13/02/2022 14/02/2022 Rp. 700.000 Layak

200902010222P000227 NANANG MUTMAINA (0000918884259) 27/02/2022 28/02/2022 Rp. 700.000 Layak

200902010222P000228 FATMAWATI (0000918887433) 16/02/2022 19/02/2022 Rp. 540.000 Layak

200902010222P000229 FIRANTIKA SARI (0001874771493) 24/02/2022 27/02/2022 Rp. 540.000 Layak

200902010222P000230 sri mulyani (0001963536208) 25/02/2022 28/02/2022 Rp. 540.000 Layak

200902010222P000231 FITRAN (0000919536265) 20/02/2022 22/02/2022 Rp. 360.000 Layak

200902010222P000232 DEITJE LONTOH (0002425525007) 08/02/2022 10/02/2022 Rp. 360.000 Layak

Tanggal, 05/04/2022
Tanggal terima FPK,
Pengaju Klaim
Verifikator