BPJS Kesehatan Cab.

DUMAI
UMPAN BALIK VERIFIKASI
PENGAJUAN KLAIM TINGKAT PERTAMA

Nomor FPK : P2203000038385

Provider : YULIANA, Amd.Keb

Bulan Pelayanan : March 2022

Pelayanan : RJTP

Pelayanan Verifikasi

Total Data : 46 Total Data : 36 Layak : 36 Tidak Layak : 10

Total Tagihan : Rp. 1.575.000 Total Tagihan : Rp. 1.325.000 Pending : 0 DIspute : 0

NO TRANSAKSI NAMA PESERTA TGL MASUK TGL PULANG BIAYA STAT KETERANGAN

B00095790322P000001 FIFI TRIYANTI (0002421303704) 02/03/2022 02/03/2022 Rp. 25.000 Tidak Layak sudah lewat jadwal PNC 1

B00095790322P000002 FIFI TRIYANTI (0002421303704) 05/03/2022 05/03/2022 Rp. 25.000 Layak

B00095790322P000003 MEGA RIANA (0000292581786) 03/03/2022 03/03/2022 Rp. 25.000 Layak

B00095790322P000004 NENI SURYANI (0000292886673) 02/03/2022 02/03/2022 Rp. 25.000 Tidak Layak sudah lewat jadwal PNC 1

B00095790322P000005 NENI SURYANI (0000292886673) 07/03/2022 07/03/2022 Rp. 25.000 Layak

B00095790322P000007 MARIA ULFA (0002042609332) 05/03/2022 05/03/2022 Rp. 25.000 Tidak Layak sudah lewat jadwal PNC 1

B00095790322P000008 MARIA ULFA (0002042609332) 08/03/2022 08/03/2022 Rp. 25.000 Layak

NELVA MONIKA AGUSTINA

B00095790322P000010 08/03/2022 08/03/2022 Rp. 25.000 Tidak Layak sudah lewat jadwal PNC 1
(0000988928739)
NELVA MONIKA AGUSTINA
B00095790322P000011 13/03/2022 13/03/2022 Rp. 25.000 Layak
(0000988928739)

B00095790322P000013 SOVI YULYANTI (0000291078527) 07/03/2022 07/03/2022 Rp. 25.000 Tidak Layak sudah lewat jadwal PNC 1

B00095790322P000014 SOVI YULYANTI (0000291078527) 12/03/2022 12/03/2022 Rp. 25.000 Layak

B00095790322P000016 SITI ROMADANI (0002249599465) 09/03/2022 09/03/2022 Rp. 25.000 Layak

B00095790322P000017 SITI ROMADANI (0002249599465) 12/03/2022 12/03/2022 Rp. 25.000 Layak

B00095790322P000019 SISKA DESIANA (0002768062869) 08/03/2022 08/03/2022 Rp. 25.000 Tidak Layak sudah lewat jadwal PNC 1

B00095790322P000020 SISKA DESIANA (0002768062869) 11/03/2022 11/03/2022 Rp. 25.000 Layak

B00095790322P000022 RATNA (0002914377287) 14/03/2022 14/03/2022 Rp. 25.000 Tidak Layak sudah lewat jadwal PNC 1

B00095790322P000023 RATNA (0002914377287) 19/03/2022 19/03/2022 Rp. 25.000 Layak

B00095790322P000025 RANI HARYATI (0000292672607) 11/03/2022 11/03/2022 Rp. 25.000 Tidak Layak sudah lewat jadwal PNC 1

B00095790322P000026 RANI HARYATI (0000292672607) 16/03/2022 16/03/2022 Rp. 25.000 Layak

B00095790322P000028 LISTIA AFRIANI (0002176885326) 27/03/2022 27/03/2022 Rp. 25.000 Tidak Layak sudah lewat jadwal PNC 1

B00095790322P000029 LISTIA AFRIANI (0002176885326) 30/03/2022 30/03/2022 Rp. 25.000 Layak

B00095790322P000031 SITI ANNISA (0000292427368) 25/03/2022 25/03/2022 Rp. 25.000 Layak

B00095790322P000032 SITI ANNISA (0000292427368) 29/03/2022 29/03/2022 Rp. 25.000 Layak

B00095790322P000034 NENI FITRIANI (0003129840718) 25/03/2022 25/03/2022 Rp. 25.000 Layak

B00095790322P000035 NENI FITRIANI (0003129840718) 27/03/2022 27/03/2022 Rp. 25.000 Layak

B00095790322P000037 SELPIA NOFIKA (0003099917193) 26/03/2022 26/03/2022 Rp. 25.000 Tidak Layak sudah lewat jadwal PNC 1
 NO TRANSAKSI NAMA PESERTA TGL MASUK TGL PULANG BIAYA STAT KETERANGAN

B00095790322P000038 SELPIA NOFIKA (0003099917193) 30/03/2022 30/03/2022 Rp. 25.000 Layak

TIARA TRISNAWATI
B00095790322P000040 26/03/2022 26/03/2022 Rp. 25.000 Layak
(0002621313459)
TIARA TRISNAWATI
B00095790322P000041 30/03/2022 30/03/2022 Rp. 25.000 Layak
(0002621313459)

B00095790322P000043 SITI ROMADANI (0002249599465) 02/03/2022 02/03/2022 Rp. 50.000 Layak

B00095790322P000044 LANNI ARI (0002242927956) 01/03/2022 01/03/2022 Rp. 50.000 Layak

B00095790322P000045 YULI MIRNAWATI (0002250960939) 11/03/2022 11/03/2022 Rp. 50.000 Layak

B00095790322P000046 SELFI RADIANTI (0001843561326) 11/03/2022 11/03/2022 Rp. 50.000 Layak

B00095790322P000047 NURSOLEHA (0002509615361) 08/03/2022 08/03/2022 Rp. 50.000 Layak

B00095790322P000048 DESI YANI (0001774580938) 11/03/2022 11/03/2022 Rp. 50.000 Layak

B00095790322P000049 SITI ANNISA (0000292427368) 07/03/2022 07/03/2022 Rp. 50.000 Layak

B00095790322P000050 NUR AZIZAH (0001634910355) 06/03/2022 06/03/2022 Rp. 50.000 Layak

B00095790322P000051 SUMI (0002313799391) 07/03/2022 07/03/2022 Rp. 50.000 Layak

B00095790322P000052 YUNI KARTIKA (0000291981521) 15/03/2022 15/03/2022 Rp. 50.000 Layak

B00095790322P000053 EFI ROSALINA (0002764668993) 14/03/2022 14/03/2022 Rp. 50.000 Layak

SITI DESSAFITRI SUPRAPTO

B00095790322P000055 21/03/2022 21/03/2022 Rp. 50.000 Layak
(0002490658896)

B00095790322P000056 YURNITA (0001737397282) 21/03/2022 21/03/2022 Rp. 50.000 Layak

B00095790322P000057 RAHMI YUNITA (0001767728632) 21/03/2022 21/03/2022 Rp. 50.000 Layak

B00095790322P000058 YEYEN SUHANA (0001886285081) 08/03/2022 08/03/2022 Rp. 50.000 Layak

B00095790322P000059 SRI ANDRI YENI (0000292646215) 04/03/2022 04/03/2022 Rp. 50.000 Layak

ANGGITA DEWI SIREGAR

B00095790322P000060 05/03/2022 05/03/2022 Rp. 50.000 Layak
(0003101639062)

Tanggal, 17/06/2022
Tanggal terima FPK,
Pengaju Klaim
Verifikator