LAMPIRAN BERITA ACARA REKONSILIASI

PENGAJUAN KLAIM BAHV BPJS KESEHATAN BAHV DISPUTE KEMENKES UANG MUKA PELUNASAN PEMBAYARAN TUNGGAKAN
KODE KURANG BAYAR / (LEBIH SISA KURANG BAYAR /
NO Nama Rumah Sakit BUKTI BUKTI BUKTI Keterangan
RUMAH SAKIT TANGGAL NILAI TANGGAL NO BAHV NILAI TANGGAL NO BAHV NILAI TANGGAL NILAI TANGGAL NILAI BAYAR) TANGGAL NILAI (LEBIH BAYAR)
Rek. Koran Bukti Transfer Rek. Koran Bukti Transfer Rek. Koran Bukti Transfer
12400145561
70 BPG 182
DIT YANKES
1192/BA/VII-12/0421
3515121 RS Umum Anwar Medika 23/04/2021 26.207.587.600 28-Apr-21 25.876.317.700 15/06/2021 25.876.317.700 RUJUKAN 3515121 - -
1193/BA/VII-12/0421
NON OPS
KLAIM COVID-
35
12400145561
70 BPG 182
DIT YANKES
1837/BA/VII-12/0621
3515121 RS Umum Anwar Medika 09/06/2021 28.177.209.200 22-Jun-21 27.842.339.200 01/10/2021 27.842.339.200 RUJUKAN 3515121 - -
1839/BA/VII-12/0621
NON OPS
KLAIM COVID-
36
12400145561
70 BPG 182
DIT YANKES
1947/BA/VII-12/0621
3515121 RS Umum Anwar Medika 25/06/2021 2.031.133.200 30-Jun-21 1.567.040.200 04/10/2021 1.567.040.200 RUJUKAN 3515121 - -
1948/BA/VII-12/0621
NON OPS
KLAIM COVID-
37
12400145561
70 BPG 182
DIT YANKES
3515121 RS Umum Anwar Medika 25/06/2021 334.730.000 30-Jun-21 1949/BA/VII-12/0621 307.525.000 04/10/2021 307.525.000 RUJUKAN 3515121 - -
NON OPS
KLAIM COVID-
38
12400145561
70 BPG 182
DIT YANKES
2570/BA/VII-12/0821
3515121 RS Umum Anwar Medika 03/08/2021 8.744.676.200 15-Aug-21 7.977.810.600 25/10/2021 7.977.810.600 RUJUKAN 3515121 - -
2569/BA/VII-12/0821
NON OPS
KLAIM COVID-
39
12400145561
70 BPG 182
DIT YANKES
3515121 RS Umum Anwar Medika 29-102-2021 243.708.700 10-Nov-21 4106/BA/VII-12/1121 138.605.400 20/12/2021 138.605.400 RUJUKAN 3515121 - -
NON OPS
KLAIM COVID-
40
12400145561
70 BPG 182
DIT YANKES
3515121 RS Umum Anwar Medika 24/08/2021 615.639.000 26-Aug-21 2692/BA/VII-12/0821 20/12/2021 615.639.000 RUJUKAN 3515121 (615.639.000) (615.639.000)
NON OPS
KLAIM COVID-
41
12400145561
70 BPG 182
DIT YANKES
3515121 RS Umum Anwar Medika 18/11/2021 105.059.100 26-Nov-21 4321/BA/VII-12/1121 105.059.100 20/12/2021 105.059.100 RUJUKAN 3515121 - -
NON OPS
KLAIM COVID-
42
12400145561
70 BPG 182
DIT YANKES
2692/BA/VII-12/0821
3515121 RS Umum Anwar Medika 24/08/2021 617.901.600 26-Aug-21 617.901.600 20/12/2021 617.901.600 RUJUKAN 3515121 - -
2687/BA/VII-12/0821
NON OPS
KLAIM COVID-
43
12400145561
70 BPG 182
DIT YANKES
3515121 RS Umum Anwar Medika 29/10/2021 52.680.216.000 18-Nov-21 4247/BA/VII-12/1121 33.798.190.000 20/12/2021 33.798.190.000 RUJUKAN 3515121 - -
NON OPS
KLAIM COVID-
44
12400145561
70 BPG 182
DIT YANKES
3515121 RS Umum Anwar Medika 14/09/2021 151.164.000 20-Sep-21 3113/BA/VII-12/0921 151.164.000 20/12/2021 151.164.000 RUJUKAN 3515121 - -
NON OPS
KLAIM COVID-
45
12400145561
70 BPG 182
DIT YANKES
3515121 RS Umum Anwar Medika 20/12/2021 151.164.000 RUJUKAN 3515121 (151.164.000) (151.164.000) double bayar
NON OPS
KLAIM COVID-
46
 12400145561
70 BPG 182
DIT YANKES
3515121 RS Umum Anwar Medika 17/09/2021 36693/TPKD.35/092021 35.129.000 27/12/2021 35.129.000 RUJUKAN 3515121 - -
NON OPS
KLAIM COVID-
47
12400145561
70 BPG 182
DIT YANKES
3515121 RS Umum Anwar Medika 02/12/2021 18.905.378.000 16-Dec-21 4656/BA/VII-12/1221 17.903.139.000 27/12/2021 17.903.139.000 RUJUKAN 3515121 - -
NON OPS
KLAIM COVID-
48
12400145561
70 BPG 182
DIT YANKES
3515121 RS Umum Anwar Medika 14/12/2021 33.229.298.160 23-Dec-21 4703/BA/VII-12/1221 32.504.705.160 27/12/2021 32.504.705.160 RUJUKAN 3515121 - -
NON OPS
KLAIM COVID-
49
12400145561
70 BPG 182
DIT YANKES
3515121 RS Umum Anwar Medika 25/10/2021 269.933.000 1-Nov-21 3793/BA/VII-12/1121 78.302.000 27/12/2021 78.302.000 RUJUKAN 3515121 - -
NON OPS
KLAIM COVID-
50
12400145561
70 BPG 182
DIT YANKES
3515121 RS Umum Anwar Medika 28/12/2021 2.262.600 RUJUKAN 3515121 (2.262.600) (2.262.600) DOUBLE BAYAR
NON OPS
KLAIM COVID-
51
12400145561
70 BPG 182
DIT YANKES
3515121 RS Umum Anwar Medika 01-Nov-21 00480/TPKD.35/11.2021 17.750.000 29/12/2021 17.750.000 RUJUKAN 3515121 - -
NON OPS
KLAIM COVID-
52
3515121 RS Umum Anwar Medika 06/07/2021 491.298.000 13-Jul-21 2130/BA/VII-12/0721 491.298.000 491.298.000 491.298.000
3515121 RS Umum Anwar Medika 20/12/2021 920.382.000 20-Dec-21 4680/BA/VII-12/1221 920.382.000 920.382.000 920.382.000
3515121 RS Umum Anwar Medika 27/12/2021 712.291.000 27-Dec-21 4734/BA/VII-12/1221 712.291.000 712.291.000 712.291.000
3515121 RS Umum Anwar Medika 27/12/2021 11.877.100 27-Dec-21 4735/BA/VII-12/1221 11.877.100 11.877.100 11.877.100
3515121 RS Umum Anwar Medika 13/12/2021 50.958.500 23-Dec-21 4704/BA/VII-12/1221 42.774.300 42.774.300 42.774.300
3515121 RS Umum Anwar Medika 10/01/2022 64.867.000 12-01-2022 161/BA/VII-12/0122 64.867.000 64.867.000 64.867.000
- -
-
- -
- -
18 - -
Sub Total Rekonsiliasi Awal 174.565.307.360 151.111.588.360 52.879.000 - 149.690.043.560 1.474.423.800 - 1.474.423.800
22984/TPKD.35/02.2022 231.432.900 231.432.900 231.432.900
- -
- -
Sub Total Rekonsiliasi Berjalan - - 231.432.900 - - 231.432.900 - 231.432.900
Total 174.565.307.360 151.111.588.360 284.311.900 - 149.690.043.560 1.705.856.700 - 1.705.856.700
LEBIH BAYAR TAHUN 2020
NILAI TEMUAN AUDIT YANG BELUM DIPOTONG
NILAI KURANG/LEBIH BAYAR 1.705.856.700

Rekapitulasi
Rekonsiliasi Awal Rekonsiliasi Berjalan Total Jakarta,
1 Total Nilai BAHV 151.164.467.360 231.432.900 151.395.900.260 PPK Klaim Covid-19 Direktur Rumah Sakit
2 Total Penerimaan 149.690.043.560 - 149.690.043.560
3 Kurang Bayar/(Lebih Bayar) 1.474.423.800 231.432.900 1.705.856.700
4 Lebih Bayar Tahun 2020 - - -
5 Nilai Temuan Audit 0 - -
6 Sisa Kurang Bayar/(Lebih Bayar) 1.474.423.800 231.432.900 1.705.856.700
7 Pembayaran Hasil Reviu BPKP - - -
8 Sisa Kurang Bayar/(Lebih Bayar) 1.474.423.800 231.432.900 1.705.856.700 Anwar A.R. dr. Nungky Taniasari, M.ARS
NIP. 197207151995031001 NIP. 488