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Rekap Klaim Rawat Inap Bulan Desember 2018

Tanggal Jumlah Klaim Inacbgs Real Cost


1 12 56,816,500 102,563,666
2 19 225,310,700 266,532,512
3 28 280,921,400 349,554,504
4 54 511,886,500 760,721,890
5 41 424,984,600 568,425,178
6 23 217,009,000 323,377,072
7 19 123,296,400 136,513,708
8 37 463,822,900 634,770,733
9 31 223,954,400 353,446,439
10 37 477,339,500 547,976,030
11 36 384,704,300 563,150,848
12 15 163,603,200 431,317,268
13 47 486,457,000 882,644,801
14 22 207,821,800 393,565,503
15 24 260,444,600 357,102,127
16 24 208,994,400 320,301,874
17 37 436,598,900 548,286,802
18 33 363,886,900 501,680,974
19 41 427,130,400 728,659,595
20 17 226,023,100 278,316,178
21 16 148,773,100 213,307,683
22 29 470,429,200 492,503,901
23 26 376,900,100 436,606,484
24 28 531,728,400 550,301,883
25 41 436,289,500 704,303,694
26 45 550,630,700 782,799,260
27 25 148,251,500 253,296,797
28 15 172,392,100 282,408,216
29 33 363,985,100 485,205,682
30 27 371,263,600 525,198,699
31 20 292,523,500 309,529,872
Total
Klaim 902 10,034,173,300 14,084,369,873
SELISIH (4,050,196,573)
r 2018
LAPORAN REKAP KLAIM - RS SENTRA MEDIKA CIBINONG
Pasien Rawat Inap dan Rawat Jalan, Periode Tanggal Pulang: 1 Jan 2019 s/d 1 Jan 2019
No. Tgl. Pulang No. RM Nama Pasien No. SEP Total Tarif Tarif RS Ceklist RS Ceklist BPJS
1 1 Jan 2019 204516 VENY ALVIONITA 0117R0760119V000002 2,033,900 1,741,646 √
2 1 Jan 2019 232244 MUHAMMAD RASYID 0117R0761218V008786 3,734,400 18,375,754 √
3 1 Jan 2019 230569 SHINDY ALVIANITA 0117R0761218V008792 2,601,900 5,852,176 √
4 1 Jan 2019 232298 MATTHEW PANDAPOTAN PARSAROAN 0117R0761218V008898 4,626,600 7,664,453 √
5 1 Jan 2019 231759 ROFIUL HIMAM 0117R0761218V009442 11,257,400 19,601,757 √
6 1 Jan 2019 231930 ABIORA FANZA DHIYA 0117R0761218V009469 11,027,800 16,564,454 √
7 1 Jan 2019 232458 KHAIKAL DHAFIN RAMADHAN 0117R0761218V009472 2,941,900 5,079,107 √
8 1 Jan 2019 52269 TAMSIYONO 0117R0761218V009598 4,854,000 12,478,539 √
9 1 Jan 2019 232552 IRWAN IBRAHIM HUTABARAT 0117R0761218V009610 2,507,900 2,724,388 √
10 1 Jan 2019 232587 RISKY AGUSTIAN 0117R0761218V009648 3,185,800 2,717,896 √
11 1 Jan 2019 231206 NEISYA AYULESTARI 0117R0761218V009721 6,370,000 2,822,851 √
12 1 Jan 2019 232594 SUMIATI 0117R0761218V009862 1,674,900 6,940,645 √
Total 56,816,500 102,563,666
Kode RS: 3201230
LAPORAN REKAP KLAIM - RS SENTRA MEDIKA CIBINONG
Pasien Rawat Inap dan Rawat Jalan, Periode Tanggal Pulang: 2 Jan 2019 s/d 2 Jan 2019
No. Tgl. Pulang No. RM Nama Pasien No. SEP Total Tarif Tarif RS Ceklist RS Ceklist BPJS
1 2 Jan 2019 232626 ROSMA SIANTURI 0117R0760119V000050 4,132,100 2,865,783 √
2 2 Jan 2019 103183 SUMIYATI 0117R0760119V000052 5,784,900 3,896,982 √
3 2 Jan 2019 206317 ACAH TARSAH 0117R0760119V000053 4,132,100 2,532,835 √
4 2 Jan 2019 32832 MAYA ROSSITA SARI 0117R0760119V000060 2,379,000 5,375,777 √
5 2 Jan 2019 105359 FOUR YANTI 0117R0760119V000065 4,958,500 3,323,554 √
6 2 Jan 2019 212306 MULYANI 0117R0760119V000066 4,958,500 3,782,480 √
7 2 Jan 2019 182514 DEDHY HOEDIYARTO 0117R0760119V000067 5,784,900 4,323,674 √
8 2 Jan 2019 232716 SELFIANA ANGGRAENY 0117R0760119V000081 7,771,000 14,861,160 √
9 2 Jan 2019 156814 DUDU KURNIAWANSAH 0117R0760119V000091 4,958,500 3,463,589 √
10 2 Jan 2019 232143 SYAFRIAL DJAFRI 0117R0760119V000259 12,210,800 12,786,836 √
11 2 Jan 2019 192200 NUR DZURRIYAAN NISA AULIYAA 0117R0761218V008245 2,722,500 7,095,629 √
12 2 Jan 2019 198619 ULIFATUS SA'DIYAH 0117R0761218V009559 11,118,700 16,453,692 √
13 2 Jan 2019 232551 ETTY SUSIANAH 0117R0761218V009608 6,795,600 12,733,968 √
14 2 Jan 2019 105868 N A RUMIASIH SE AKT MM 0117R0761218V009615 3,622,000 12,283,349 √
15 2 Jan 2019 206465 MARYANI 0117R0761218V009617 8,041,000 20,795,057 √
16 2 Jan 2019 232557 A DANIAH 0117R0761218V009621 58,821,400 61,963,350 √
17 2 Jan 2019 19000 SHINTA DEWI 0117R0761218V009629 14,456,700 25,818,564 √
18 2 Jan 2019 105294 JOANA KIANTY 0117R0761218V009643 3,841,100 4,512,813 √
19 2 Jan 2019 110321 MOCH NAFHAN 0117R0761218V009745 58,821,400 47,663,420 √
Total 225,310,700 266,532,512
Kode RS: 32012
LAPORAN REKAP KLAIM - RS SENTRA MEDIKA CIBINONG
Pasien Rawat Inap dan Rawat Jalan, Periode Tanggal Pulang: 3 Jan 2019 s/d 3 Jan 2019
No. Tgl. Pulang No. RM Nama Pasien No. SEP Total Tarif Tarif RS Ceklist RS Ceklist BPJS
1 3 Jan 2019 185486 FARIDA TRI WIDYASTI 0117R0760119V000085 2,344,900 10,260,021 √
2 3 Jan 2019 143740 BUN BUN SIANG 0117R0760119V000088 2,663,700 10,643,074 √
3 3 Jan 2019 151159 SUMIYATI 0117R0760119V000095 7,293,200 6,635,506 √
4 3 Jan 2019 231338 OBAY YAS A 0117R0760119V000162 58,821,400 48,997,193 √
5 3 Jan 2019 1157 NELLY HAFNI HASIBUAN 0117R0760119V000168 7,609,600 13,598,603 √
6 3 Jan 2019 227448 SUNARSIH 0117R0760119V000362 4,958,500 3,505,261 √
7 3 Jan 2019 232780 ENONG HOLILAH 0117R0760119V000384 12,472,300 23,974,728 √
8 3 Jan 2019 178473 LILIS SURYANI 0117R0760119V000392 4,340,500 9,929,086 √
9 3 Jan 2019 216460 KHODIJAH 0117R0760119V000407 10,690,500 11,585,033 √
10 3 Jan 2019 224372 ENGKOS KOSASIH 0117R0760119V000432 4,132,100 3,092,921 √
11 3 Jan 2019 209198 RADEN DONO HENDRA PRAYITNO 0117R0760119V000450 5,784,900 3,378,729 √
12 3 Jan 2019 231523 SUYANTO 0117R0760119V000451 23,198,900 22,109,499 √
13 3 Jan 2019 175586 SHANDY RAMDANI 0117R0760119V000457 4,958,500 3,684,045 √
14 3 Jan 2019 177200 SA'ARIN BIN SAERAN 0117R0760119V000473 6,077,700 6,148,617 √
15 3 Jan 2019 215064 SISWANTI 0117R0760119V000477 4,958,500 10,028,410 √
16 3 Jan 2019 223261 SUTIO 0117R0760119V000482 6,077,700 8,420,960 √
17 3 Jan 2019 231634 MUZAINI 0117R0760119V000489 4,340,500 18,819,966 √
18 3 Jan 2019 223495 IDA ARYANI 0117R0760119V000515 4,132,100 2,605,507 √
19 3 Jan 2019 229138 RUDOLF SOAR 0117R0760119V000517 4,132,100 3,548,721 √
20 3 Jan 2019 42799 YATI SUPRIYATIN 0117R0760119V000529 40,790,100 17,756,291 √
21 3 Jan 2019 198051 MUHIDIN 0117R0760119V000535 4,132,100 2,717,597 √
22 3 Jan 2019 105603 KRISTIYANTO DWI SUSANTO 0117R0760119V000543 5,784,900 3,693,706 √
23 3 Jan 2019 229829 DAMANHURI 0117R0760119V001041 2,451,500 2,251,248 √
24 3 Jan 2019 232088 TUTI SUTIRAH 0117R0761218V008022 22,787,900 46,167,875 √
25 3 Jan 2019 95930 ASEP SAEPULOH 0117R0761218V009491 12,472,300 31,065,399 √
26 3 Jan 2019 232578 DALILAH 0117R0761218V009639 4,697,800 12,794,956 √
27 3 Jan 2019 232600 NIJAR MAULANA 0117R0761218V009794 4,335,900 5,786,127 √
28 3 Jan 2019 232647 FAUZAN ADZIMA TOHARI 0117R0761218V009825 4,481,300 6,355,425 √
Total 280,921,400 349,554,504
Kode RS: 320123
LAPORAN REKAP KLAIM - RS SENTRA MEDIKA CIBINONG
Pasien Rawat Inap dan Rawat Jalan, Periode Tanggal Pulang: 4 Jan 2019 s/d 4 Jan 2019
No. Tgl. Pulang No. RM Nama Pasien No. SEP Total Tarif Tarif RS Ceklist RS Ceklist BPJS
1 4 Jan 2019 224122 MARSHA 0117R0760119V000064 6,981,500 20,093,258 √
2 4 Jan 2019 8775 ARBAIN 0117R0760119V000069 2,507,900 5,332,645 √
3 4 Jan 2019 28322 TRI AJENG LEKSONO WATI 0117R0760119V000092 5,984,100 13,573,572 √
4 4 Jan 2019 217174 BAMBANG NUGROHO RUDIJANTO 0117R0760119V000093 6,795,600 13,070,538 √
5 4 Jan 2019 124709 ERNA HERAWATY 0117R0760119V000096 4,126,300 14,783,187 √
6 4 Jan 2019 232735 NURJANAH 0117R0760119V000099 9,856,000 18,507,885 √
7 4 Jan 2019 232737 ABIDIN 0117R0760119V000328 40,790,100 19,497,208 √
8 4 Jan 2019 232762 NOMI 0117R0760119V000388 19,332,400 13,649,309 √
9 4 Jan 2019 232775 MUGIASIH 0117R0760119V000408 12,472,300 13,933,712 √
10 4 Jan 2019 232785 MIMIN 0117R0760119V000463 12,472,300 14,040,940 √
11 4 Jan 2019 155411 HERI KURNIAWAN 0117R0760119V000531 2,925,900 3,506,891 √
12 4 Jan 2019 232282 BAYI NY SITI RACHMAWATI 0117R0760119V000532 5,045,200 3,385,905 √
13 4 Jan 2019 205254 ARIEF BUDIANTO 0117R0760119V000556 58,821,400 48,729,587 √
14 4 Jan 2019 221115 IRIANTO 0117R0760119V000557 45,079,800 42,802,608 √
15 4 Jan 2019 119811 HADI MULIAWANTO 0117R0760119V000632 5,163,500 14,551,303 √
16 4 Jan 2019 231202 IRMA WAHYUNINGSIH 0117R0760119V000655 6,370,000 13,373,730 √
17 4 Jan 2019 230417 YENI HERAWATI 0117R0760119V000661 6,370,000 13,606,373 √
18 4 Jan 2019 228857 MARDHIN PHASLA 0117R0760119V000682 7,431,700 17,468,418 √
19 4 Jan 2019 229813 KHAIRUNNISA FAUZIAH 0117R0760119V000802 5,308,400 10,456,007 √
20 4 Jan 2019 44549 NOVA ANDIKA 0117R0760119V000869 5,784,900 3,584,677 √
21 4 Jan 2019 213676 SAEPUDIN ZUHRI 0117R0760119V000873 4,132,100 2,868,647 √
22 4 Jan 2019 132026 BUDI EKA DHARMA 0117R0760119V000876 5,784,900 3,516,220 √
23 4 Jan 2019 202192 NURMINAH 0117R0760119V000878 4,958,500 3,118,277 √
24 4 Jan 2019 232810 BY NY TRI AJENG LEKSONO WATI 0117R0760119V000915 4,386,800 510,282 √
25 4 Jan 2019 205424 KOMIN 0117R0760119V000917 8,908,800 18,756,796 √
26 4 Jan 2019 232907 CECEP SUHENDAR 0117R0760119V000964 5,208,600 22,260,577 √
27 4 Jan 2019 231954 SYAEFUL BAHRI 0117R0760119V000980 10,690,500 22,176,686 √
28 4 Jan 2019 220516 MUCH HENI FUDJI 0117R0760119V000982 10,690,500 22,400,920 √
29 4 Jan 2019 185203 FATIMAH 0117R0760119V000991 19,332,400 19,139,195 √
30 4 Jan 2019 137978 DJUBAEDAH 0117R0760119V000996 4,340,500 18,757,295 √
31 4 Jan 2019 115465 ARIEF NOERACHMAN SAPUTRO 0117R0760119V001002 4,958,500 4,064,876 √
32 4 Jan 2019 39685 MUKLIS 0117R0760119V001020 4,132,100 3,634,497 √
33 4 Jan 2019 156197 MAESAROH 0117R0760119V001021 4,958,500 4,230,799 √
34 4 Jan 2019 226251 BUHERMAN 0117R0760119V001022 4,132,100 3,194,915 √
35 4 Jan 2019 233001 NURUL AZIZAH 0117R0760119V001043 1,674,900 4,522,425 √
36 4 Jan 2019 232984 INAH 0117R0760119V001048 5,153,300 5,218,970 √
37 4 Jan 2019 196155 HAMZAH BISRI 0117R0760119V001049 4,132,100 3,559,220 √
38 4 Jan 2019 107159 SILMI BAHIYA 0117R0760119V001050 4,126,300 3,001,462 √
39 4 Jan 2019 70010 WARSIH 0117R0760119V001133 17,095,200 13,728,359 √
40 4 Jan 2019 233023 M DADANG PRIATNA 0117R0760119V001336 3,983,300 2,704,827 √
41 4 Jan 2019 42751 CINTA SYAFITRI RIYADI 0117R0760119V001392 29,135,800 9,776,587 √
42 4 Jan 2019 215079 DEWI NINGSIH 0117R0760119V001396 2,300,600 4,968,290 √
43 4 Jan 2019 232338 APSANIH 0117R0761218V009326 4,122,000 12,099,668 √
44 4 Jan 2019 170935 KUSMAN 0117R0761218V009606 9,841,500 26,972,968 √
45 4 Jan 2019 151169 KAMIRUL HENDRA,SH 0117R0761218V009607 8,807,500 35,724,238 √
46 4 Jan 2019 225300 SRI HARTINI 0117R0761218V009618 11,740,200 19,622,807 √
47 4 Jan 2019 232565 SUHARTO.SM 0117R0761218V009625 5,180,900 19,417,142 √
48 4 Jan 2019 231376 NANI IRAWATI 0117R0761218V009787 9,150,100 37,653,435 √
49 4 Jan 2019 232571 AHMAD ZAKY 0117R0761218V009814 4,300,600 33,774,292 √
50 4 Jan 2019 232644 ABDUL HAER 0117R0761218V009924 2,033,900 5,076,090 √
51 4 Jan 2019 232704 MUHAMMAD NABHAN ROBBANI 0117R0761218V009927 2,507,900 6,001,307 √
52 4 Jan 2019 232705 AHMAD R 0117R0761218V009928 6,291,000 17,028,004 √
53 4 Jan 2019 232696 MIMIE SOEARDY 0117R0761218V009935 6,782,100 6,653,667 √
54 4 Jan 2019 232593 MIKHAEL KAMI 0117R0761218V009936 7,293,200 26,640,397 √
Total 511,886,500 760,721,890
Kode RS: 3201230
LAPORAN REKAP KLAIM - RS SENTRA MEDIKA CIBINONG
Pasien Rawat Inap dan Rawat Jalan, Periode Tanggal Pulang: 5 Jan 2019 s/d 5 Jan 2019
No. Tgl. Pulang No. RM Nama Pasien No. SEP Total Tarif Tarif RS Ceklist RS Ceklist BPJS
1 5 Jan 2019 130754 DARNI 0117R0760119V000007 10,518,600 15,386,573 √
2 5 Jan 2019 192614 SOEDRADJAT, SH 0117R0760119V000086 7,684,500 15,805,396 √
3 5 Jan 2019 232721 RIZQI IBRAHIM 0117R0760119V000087 22,780,800 27,975,028 √
4 5 Jan 2019 232731 SULANJANA SEPTIAN PRATINGGO 0117R0760119V000097 9,856,000 17,476,122 √
5 5 Jan 2019 232733 DADANG SASMITA 0117R0760119V000098 11,182,000 26,434,697 √
6 5 Jan 2019 226682 JOHANSEN LIE SAHENDRATA 0117R0760119V000101 5,058,500 4,718,572 √
7 5 Jan 2019 232734 M YUSUF SALLIM RANGKUTI 0117R0760119V000404 2,722,500 4,179,981 √
8 5 Jan 2019 65843 RAZIANA ZEBUA 0117R0760119V000455 5,784,900 10,244,828 √
9 5 Jan 2019 73022 MUHAMAD MARSAN 0117R0760119V000500 7,715,900 6,250,476 √
10 5 Jan 2019 200155 SAFWAN AZRIL SUTRESNA 0117R0760119V000525 2,722,500 4,164,802 √
11 5 Jan 2019 227181 AZKA RAFFASYA 0117R0760119V000679 2,538,800 3,302,318 √
12 5 Jan 2019 166650 HELGA AYU AQILA RAHMAH 0117R0760119V000796 2,405,100 3,366,778 √
13 5 Jan 2019 232890 TRI AGUSTINAH 0117R0760119V000825 6,981,500 15,047,414 √
14 5 Jan 2019 182077 FERDY HASAN 0117R0760119V000908 5,886,000 3,570,258 √
15 5 Jan 2019 89438 ANWAR 0117R0760119V000923 6,496,700 6,435,553 √
16 5 Jan 2019 232717 MUAHMMAD ARDHYMAS LAZUARDI 0117R0760119V000928 4,626,600 10,593,618 √
17 5 Jan 2019 232964 EFENDI SOFIAN, SE 0117R0760119V001006 4,481,300 3,712,516 √
18 5 Jan 2019 227584 SUKATMA 0117R0760119V001028 45,079,800 41,554,475 √
19 5 Jan 2019 149138 AZKA ALKHALIFI AMMAR 0117R0760119V001056 2,061,500 2,440,658 √
20 5 Jan 2019 41733 ATIATUL BUSYRA 0117R0760119V001064 2,775,400 7,924,380 √
21 5 Jan 2019 231678 MUHAMMAD AKMAL A 0117R0760119V001152 11,182,000 13,058,994 √
22 5 Jan 2019 232815 H.R SUBANDI WIDJAJA 0117R0760119V001162 45,079,800 40,798,200 √
23 5 Jan 2019 233040 DIDIK ADI PRAYITNO , IR 0117R0760119V001381 12,472,300 13,827,941 √
24 5 Jan 2019 189186 SAMSUL 0117R0760119V001386 7,808,800 7,383,647 √
25 5 Jan 2019 233038 A.H.M YUSUF 0117R0760119V001389 12,472,300 13,799,251 √
26 5 Jan 2019 214563 NANI MULYANI 0117R0760119V001407 4,340,500 9,788,837 √
27 5 Jan 2019 232958 BY NY TRI AGUSTINAH 0117R0760119V001416 5,118,000 966,084 √
28 5 Jan 2019 228415 KHO, KIM HAN 0117R0760119V001417 27,065,300 13,240,810 √
29 5 Jan 2019 225803 ANIH 0117R0760119V001418 8,908,800 8,420,992 √
30 5 Jan 2019 214033 SITI SAPUROH 0117R0760119V001424 10,690,500 22,502,727 √
31 5 Jan 2019 231733 MERI GUSNAWATI 0117R0760119V001431 5,208,600 22,444,948 √
32 5 Jan 2019 145875 RUDI HERMAN P 0117R0760119V001524 8,877,800 13,600,224 √
33 5 Jan 2019 231445 RACHMAT HIDAYAT 0117R0760119V001528 6,341,300 10,954,351 √
34 5 Jan 2019 233080 BY NY ATIATUL BUSYRA 0117R0760119V001534 5,118,000 870,684 √
35 5 Jan 2019 104281 TJONG KIM NGO 0117R0760119V001566 5,784,900 3,813,498 √
36 5 Jan 2019 233133 ANDANG ISKANDAR 0117R0760119V001577 2,925,900 3,728,792 √
37 5 Jan 2019 232196 ARRAFI MAULANA AKBAR 0117R0761218V008457 3,965,700 27,770,226 √
38 5 Jan 2019 3159 HADITOMO 0117R0761218V009612 58,821,400 77,632,523 √
39 5 Jan 2019 181104 RUSTINI 0117R0761218V009614 5,058,500 17,474,187 √
40 5 Jan 2019 232697 TINO ROBERT LINOGI 0117R0761218V009918 5,877,400 9,142,417 √
41 5 Jan 2019 232699 SUGIYARTI 0117R0761218V009937 2,507,900 6,621,402 √
Total 424,984,600 568,425,178
Kode RS: 3201230
LAPORAN REKAP KLAIM - RS SENTRA MEDIKA CIBINONG
Pasien Rawat Inap dan Rawat Jalan, Periode Tanggal Pulang: 6 Jan 2019 s/d 6 Jan 2019
No. Tgl. Pulang No. RM Nama Pasien No. SEP Total Tarif Tarif RS Ceklist RS Ceklist BPJS
1 6 Jan 2019 194230 ABYAN DWI H 0117R0760119V000124 3,176,200 4,107,742 √
2 6 Jan 2019 148274 JACKY ROMY WALUKOW 0117R0760119V000541 5,045,200 4,069,630 √
3 6 Jan 2019 232881 KOMARIAH 0117R0760119V000753 5,886,000 5,051,371 √
4 6 Jan 2019 162040 NURDJANI DAHLAN 0117R0760119V000899 7,293,200 5,726,834 √
5 6 Jan 2019 232803 HENDRA HAKIM 0117R0760119V001015 8,291,400 7,583,602 √
6 6 Jan 2019 182687 POPI OKTAVIANI 0117R0760119V001044 2,722,500 3,514,553 √
7 6 Jan 2019 233002 MUHAMMAD FAISHOL FILBRRI 0117R0760119V001047 2,061,500 2,903,650 √
8 6 Jan 2019 228398 SOLICHAN 0117R0760119V001201 9,783,500 15,672,583 √
9 6 Jan 2019 203090 SADIYAH 0117R0760119V001215 9,584,600 19,530,491 √
10 6 Jan 2019 233071 NACITA ADZKIA S 0117R0760119V001387 3,718,200 3,864,627 √
11 6 Jan 2019 228875 MUHAMAD PUTRA PRATAMA 0117R0760119V001540 2,538,800 2,510,875 √
12 6 Jan 2019 232053 HAIDI HUWAINA 0117R0760119V001590 3,479,400 3,337,414 √
13 6 Jan 2019 231814 AMZALUWI 0117R0760119V001647 23,198,900 21,992,464 √
14 6 Jan 2019 231504 AAN 0117R0760119V001661 10,690,500 21,801,101 √
15 6 Jan 2019 231812 MOHAMAD KAHFI 0117R0760119V001663 12,472,300 13,474,472 √
16 6 Jan 2019 232175 ACHMAD.S. KOM 0117R0760119V001696 12,472,300 23,972,173 √
17 6 Jan 2019 233180 MUHTAR 0117R0760119V001698 8,908,800 9,816,672 √
18 6 Jan 2019 40797 NENENG YUNINGSIH 0117R0760119V001711 40,790,100 20,123,059 √
19 6 Jan 2019 11841 YEDI MARYADI 0117R0760119V001720 4,958,500 4,316,607 √
20 6 Jan 2019 232072 DRS. SUPARMAN 0117R0761218V007981 10,244,500 57,466,087 √
21 6 Jan 2019 229076 NOVIYANA MEGASARI 0117R0761218V009438 11,740,200 26,889,563 √
22 6 Jan 2019 232523 ACHMAD NUR ALAMIN 0117R0761218V009580 7,221,000 20,315,190 √
23 6 Jan 2019 232559 NORMAWATI 0117R0761218V009624 10,731,400 25,336,312 √
Total 217,009,000 323,377,072
Kode RS: 320123
LAPORAN REKAP KLAIM - RS SENTRA MEDIKA CIBINONG
Pasien Rawat Inap dan Rawat Jalan, Periode Tanggal Pulang: 7 Jan 2019 s/d 7 Jan 2019
No. Tgl. Pulang No. RM Nama Pasien No. SEP Total Tarif Tarif RS Ceklist RS Ceklist BPJS
1 7 Jan 2019 127099 VANI NUR FITRIAN 0117R0760119V000540 3,841,100 6,623,309 √
2 7 Jan 2019 11747 RIZAZUL MUSTOLEH 0117R0760119V000896 2,722,500 4,877,664 √
3 7 Jan 2019 97107 SURGANI 0117R0760119V000907 4,482,300 13,394,086 √
4 7 Jan 2019 232989 DELISA 0117R0760119V001035 3,393,400 1,825,085 √
5 7 Jan 2019 233020 MIKHAYLA ARUNA 0117R0760119V001151 5,058,500 5,271,849 √
6 7 Jan 2019 233019 DAVINA CARISYA 0117R0760119V001158 3,176,200 5,397,763 √
7 7 Jan 2019 233115 KETTRIN 0117R0760119V001569 2,722,500 2,686,912 √
8 7 Jan 2019 233122 S HERYANTO 0117R0760119V001574 12,140,800 16,247,918 √
9 7 Jan 2019 213861 WULAN SAFITRI 0117R0760119V001583 2,775,400 13,089,029 √
10 7 Jan 2019 191105 MARADEN HUTAJULU 0117R0760119V001710 2,722,500 3,492,742 √
11 7 Jan 2019 233155 KUSNAWATI 0117R0760119V001856 7,609,600 13,753,979 √
12 7 Jan 2019 233308 ALI AZHAR 0117R0760119V001860 6,963,100 3,408,387 √
13 7 Jan 2019 233313 AMIN 0117R0760119V001863 8,877,800 14,269,091 √
14 7 Jan 2019 233321 SUHARNINGSIH 0117R0760119V001884 2,601,900 2,570,734 √
15 7 Jan 2019 233280 NADYA MAULIDA 0117R0760119V002261 3,393,400 1,990,556 √
16 7 Jan 2019 131519 JUANDA IRAWAN 0117R0760119V002323 6,909,500 2,676,351 √
17 7 Jan 2019 233446 AGUNG BUDAYA 0117R0760119V002366 29,135,800 6,950,227 √
18 7 Jan 2019 91401 KASPUN 0117R0760119V002475 8,672,200 3,978,917 √
19 7 Jan 2019 189778 HJ. SITI AMINAH 0117R0761218V009404 6,097,900 14,009,109 √
Total 123,296,400 136,513,708
Kode RS: 3201230
LAPORAN REKAP KLAIM - RS SENTRA MEDIKA CIBINONG
Pasien Rawat Inap dan Rawat Jalan, Periode Tanggal Pulang: 8 Jan 2019 s/d 8 Jan 2019
No. Tgl. Pulang No. RM Nama Pasien No. SEP Total Tarif Tarif RS Ceklist RS Ceklist BPJS
1 8 Jan 2019 176684 JOHN PRIGALIH 0117R0760119V000061 12,266,900 30,862,590 √
2 8 Jan 2019 25923 MANGONTANG TAMPUBOLON S.SOS 0117R0760119V000839 9,446,100 7,877,115 √
3 8 Jan 2019 230904 AZWIN HAMDANI MANGUNSONG 0117R0760119V000904 58,821,400 60,246,830 √
4 8 Jan 2019 232891 AHMAD FAUZI 0117R0760119V000968 2,507,900 5,299,583 √
5 8 Jan 2019 152824 HENDRY WIDYAMAN. SH 0117R0760119V001061 12,266,900 15,778,743 √
6 8 Jan 2019 233015 PUTRI APRILLIA 0117R0760119V001067 2,925,900 4,704,235 √
7 8 Jan 2019 121742 MEGAYANTI 0117R0760119V001546 5,045,200 7,942,940 √
8 8 Jan 2019 814 MUHAMMAD ALVIN ALFARIZKI RENAOE 0117R0760119V001637 12,140,800 20,259,764 √
9 8 Jan 2019 233231 RETNO WILIS 0117R0760119V001814 2,722,500 2,864,019 √
10 8 Jan 2019 205795 VINTANG SETYA R 0117R0760119V001818 2,507,900 3,546,468 √
11 8 Jan 2019 233268 DAFFA RAFIF ARKHAN 0117R0760119V001822 2,507,900 3,110,199 √
12 8 Jan 2019 213516 SYARIFAH HANIM ,S .PSI 0117R0760119V001826 2,344,900 10,850,526 √
13 8 Jan 2019 233302 RIKA NURGIANI 0117R0760119V001841 2,327,000 2,799,224 √
14 8 Jan 2019 227307 MULYATI 0117R0760119V001859 58,821,400 50,560,922 √
15 8 Jan 2019 214568 NIKEN NATASYA 0117R0760119V001865 2,090,000 1,553,675 √
16 8 Jan 2019 233315 MOCHAMMAD RADITYA PRATAMA 0117R0760119V001868 3,554,300 3,718,391 √
17 8 Jan 2019 233324 HISYAM UBAIDILLAH 0117R0760119V001906 2,061,500 1,898,938 √
18 8 Jan 2019 231211 RATIH NOKOWATI 0117R0760119V001958 7,431,700 14,803,736 √
19 8 Jan 2019 97789 HERU SUBASYO 0117R0760119V001998 40,790,100 16,926,213 √
20 8 Jan 2019 232599 DANIEL FERDIAN 0117R0760119V002001 46,734,600 53,595,390 √
21 8 Jan 2019 230422 ASEP SUPRIATNA 0117R0760119V002019 5,308,400 11,712,937 √
22 8 Jan 2019 232146 ACHYAR 0117R0760119V002037 58,821,400 49,219,317 √
23 8 Jan 2019 226458 SUNARTO 0117R0760119V002069 4,680,900 10,034,705 √
24 8 Jan 2019 154749 SANIA KUROTA AKYUNIN 0117R0760119V002073 7,431,700 15,042,200 √
25 8 Jan 2019 233263 M. SALMAN YAZID ZIDAN 0117R0760119V002199 3,536,800 16,316,371 √
26 8 Jan 2019 10755 FARIDA YUSRI 0117R0760119V002211 4,680,900 14,620,670 √
27 8 Jan 2019 191871 TRI HASTARI 0117R0760119V002258 8,908,800 9,915,969 √
28 8 Jan 2019 233248 LALA SAEPUL BAHRI 0117R0760119V002284 4,425,900 2,716,050 √
29 8 Jan 2019 233333 LUSI HERAWATI NAINGGOLAN 0117R0760119V002289 4,340,500 9,807,310 √
30 8 Jan 2019 189904 SUMARNI 0117R0760119V002319 4,132,100 3,321,594 √
31 8 Jan 2019 231442 AGUSTINUS ROY JANTO 0117R0760119V002404 12,472,300 24,164,501 √
32 8 Jan 2019 231926 SUPRIYONO 0117R0760119V002446 7,609,600 12,361,450 √
33 8 Jan 2019 225775 SULARTI S 0117R0760119V002448 12,472,300 13,465,909 √
34 8 Jan 2019 38306 SUKO SULISTIO 0117R0760119V002459 14,653,000 12,092,708 √
35 8 Jan 2019 221975 ARIEF RACHMAN 0117R0760119V002870 7,665,300 6,828,392 √
36 8 Jan 2019 59062 ARIF MUSTAKIM 0117R0760119V002961 2,961,500 8,752,425 √
37 8 Jan 2019 221266 LYDIAWATI 0117R0761218V005902 10,406,600 95,198,724 √
Total 463,822,900 634,770,733
Kode RS: 320123
LAPORAN REKAP KLAIM - RS SENTRA MEDIKA CIBINONG
Pasien Rawat Inap dan Rawat Jalan, Periode Tanggal Pulang: 9 Jan 2019 s/d 9 Jan 2019
No. Tgl. Pulang No. RM Nama Pasien No. SEP Total Tarif Tarif RS Ceklist RS Ceklist BPJS
1 9 Jan 2019 18794 YUSUP 0117R0760119V000819 1,452,800 4,630,611 √
2 9 Jan 2019 182767 ELLY GUSTINI 0117R0760119V000909 12,391,500 21,155,375 √
3 9 Jan 2019 232950 BINTANG NAUFAL W 0117R0760119V001567 3,841,100 14,248,517 √
4 9 Jan 2019 233142 MELISA PUTRI SALSABILA 0117R0760119V001572 3,718,200 5,168,179 √
5 9 Jan 2019 233140 IRMA NURMAYANI 0117R0760119V001578 9,673,300 9,274,116 √
6 9 Jan 2019 131447 GALIH DWI PRAYOGO 0117R0760119V001588 3,176,200 5,135,160 √
7 9 Jan 2019 210931 MARDIYAH 0117R0760119V001683 7,703,700 7,169,362 √
8 9 Jan 2019 125661 H MAMAD FARMA 0117R0760119V001838 8,555,800 16,316,552 √
9 9 Jan 2019 233299 APRILIYA HAPPY AYU NINGTYAS 0117R0760119V001842 2,507,900 4,204,811 √
10 9 Jan 2019 233148 SUPRIANA 0117R0760119V001849 3,841,100 4,540,643 √
11 9 Jan 2019 84557 FELLYANI KALUKU 0117R0760119V001850 6,981,500 16,797,685 √
12 9 Jan 2019 233314 MUHAMMAD RIDWAN 0117R0760119V001870 5,073,100 5,200,179 √
13 9 Jan 2019 132969 DAHNIAR 0117R0760119V001973 6,981,500 13,310,115 √
14 9 Jan 2019 128050 SHAULLA JAYANTHI AURA 0117R0760119V002056 7,892,000 13,207,731 √
15 9 Jan 2019 1474 SRI MINARSIH 0117R0760119V002223 4,133,500 5,275,440 √
16 9 Jan 2019 100306 MUHAMMAD ZAENI 0117R0760119V002246 2,033,900 3,707,328 √
17 9 Jan 2019 141863 H. SYAMSUL RIZAL 0117R0760119V002415 4,640,500 1,702,035 √
18 9 Jan 2019 232810 BY NY TRI AJENG LEKSONO WATI 0117R0760119V002428 4,386,800 3,688,244 √
19 9 Jan 2019 218001 DEDAH APRIANI 0117R0760119V002452 24,212,000 33,534,313 √
20 9 Jan 2019 233449 GABRIELLA PUTRI APRILLIA R 0117R0760119V002465 1,718,000 1,968,119 √
21 9 Jan 2019 67090 OLIVIA 0117R0760119V002472 2,722,500 3,594,075 √
22 9 Jan 2019 233509 IRFAN HASAN 0117R0760119V002584 8,877,800 16,417,509 √
23 9 Jan 2019 233531 KARNOTO 0117R0760119V002788 4,340,500 18,727,337 √
24 9 Jan 2019 231825 NASEM 0117R0760119V002790 19,332,400 18,736,992 √
25 9 Jan 2019 20616 REVANA DINIYASWARI KHOFIFAH 0117R0760119V002800 2,722,500 1,591,117 √
26 9 Jan 2019 178196 FERRYANTO WIBOWO 0117R0760119V002805 23,032,500 30,914,878 √
27 9 Jan 2019 233466 BAYI NYONYA FELLYANI KALUKU 0117R0760119V002824 5,118,000 1,354,294 √
28 9 Jan 2019 233529 FADILLAH 0117R0760119V002949 8,908,800 18,776,971 √
29 9 Jan 2019 233427 BY NY DAHNIAR 0117R0760119V003305 5,118,000 701,084 √
30 9 Jan 2019 232426 RILO PAMBUDI 0117R0761218V009457 11,481,700 37,368,164 √
31 9 Jan 2019 117004 CAMING 0117R0761218V009903 7,385,300 15,029,503 √
Total 223,954,400 353,446,439
Kode RS: 3201230
LAPORAN REKAP KLAIM - RS SENTRA MEDIKA CIBINONG
Pasien Rawat Inap dan Rawat Jalan, Periode Tanggal Pulang: 10 Jan 2019 s/d 10 Jan 2019
No. Tgl. Pulang No. RM Nama Pasien No. SEP Total Tarif Tarif RS Ceklist RS Ceklist BPJS
1 10 Jan 2019 122834 BARKAH 0117R0760119V001261 1,718,000 4,866,740 √
2 10 Jan 2019 67276 ERTINA WIJAYANTI 0117R0760119V001830 3,855,500 6,999,785 √
3 10 Jan 2019 233306 DIAH AYU HANDAYANI 0117R0760119V001852 2,925,900 6,638,592 √
4 10 Jan 2019 233325 ALIYAH RIZKI R 0117R0760119V001946 2,538,800 3,710,207 √
5 10 Jan 2019 103527 SHAREEN NADHIVA BUANA 0117R0760119V001947 3,349,800 4,360,469 √
6 10 Jan 2019 232174 RISKA CHOIRIA I 0117R0760119V001951 6,535,800 11,788,468 √
7 10 Jan 2019 199141 IGN. HERRY DJOKO 0117R0760119V002046 8,508,800 18,116,544 √
8 10 Jan 2019 233383 DISMAN 0117R0760119V002175 2,507,900 3,728,808 √
9 10 Jan 2019 212957 OMAN RABUN 0117R0760119V002220 10,605,500 20,435,398 √
10 10 Jan 2019 182495 BY NY TETI SRIHARTETI 0117R0760119V002233 3,187,000 4,210,882 √
11 10 Jan 2019 207419 SITI HAJAR KHAYRA FAZILA 0117R0760119V002463 2,061,500 2,627,691 √
12 10 Jan 2019 233429 MAISAROH 0117R0760119V002467 2,405,100 4,101,632 √
13 10 Jan 2019 233480 HERRY SETIAWAN 0117R0760119V002470 3,200,900 2,588,237 √
14 10 Jan 2019 233520 RONALD TOMASOA 0117R0760119V002776 27,065,300 13,936,561 √
15 10 Jan 2019 148663 FIRDAUS SIHALOHO 0117R0760119V002794 4,204,300 3,835,304 √
16 10 Jan 2019 88958 SISILYA FEBRYNA 0117R0760119V002968 2,061,500 2,282,095 √
17 10 Jan 2019 170014 FADHIL ALFHAREZA 0117R0760119V003074 1,467,400 7,963,584 √
18 10 Jan 2019 183490 HERU 0117R0760119V003091 7,310,800 5,962,678 √
19 10 Jan 2019 231539 ALIH 0117R0760119V003124 19,082,700 34,015,249 √
20 10 Jan 2019 229248 DWI HARYANI 0117R0760119V003188 58,821,400 44,552,171 √
21 10 Jan 2019 232785 MIMIN 0117R0760119V003211 27,065,300 24,474,078 √
22 10 Jan 2019 232775 MUGIASIH 0117R0760119V003223 12,472,300 23,826,052 √
23 10 Jan 2019 232232 ANDI MUBARA 0117R0760119V003228 58,821,400 51,479,403 √
24 10 Jan 2019 230650 MUHTARUDIN 0117R0760119V003232 58,821,400 49,728,614 √
25 10 Jan 2019 224452 ENDAY BIN H.MINAN 0117R0760119V003237 12,210,800 11,326,022 √
26 10 Jan 2019 231991 SUPRIATNA 0117R0760119V003267 58,821,400 47,408,771 √
27 10 Jan 2019 233624 BENAH 0117R0760119V003277 10,690,500 22,185,749 √
28 10 Jan 2019 233631 HENDRI 0117R0760119V003282 4,340,500 18,814,668 √
29 10 Jan 2019 233625 JAMARI 0117R0760119V003283 4,340,500 9,913,630 √
30 10 Jan 2019 233640 NEMAN 0117R0760119V003284 10,690,500 22,307,575 √
31 10 Jan 2019 232593 MIKHAEL KAMI 0117R0760119V003294 10,690,500 11,534,011 √
32 10 Jan 2019 202966 INDAHYANA 0117R0760119V003387 4,315,600 8,327,929 √
33 10 Jan 2019 231941 BUDI YANTO 0117R0760119V003440 6,341,300 11,548,548 √
34 10 Jan 2019 27211 NENENG IRAWATI 0117R0760119V003441 3,220,800 8,073,479 √
35 10 Jan 2019 232314 UJANG RAHMAT 0117R0760119V003446 12,210,800 11,874,272 √
36 10 Jan 2019 233172 HELLIN PUTRILIANTO DWI RAMDHANI0117R0760119V003464 2,760,700 6,921,826 √
37 10 Jan 2019 204040 OMI 0117R0760119V003935 6,111,300 1,510,308 √
Total 477,339,500 547,976,030
Kode RS: 3201230
LAPORAN REKAP KLAIM - RS SENTRA MEDIKA CIBINONG
Pasien Rawat Inap dan Rawat Jalan, Periode Tanggal Pulang: 11 Jan 2019 s/d 11 Jan 2019
No. Tgl. Pulang No. RM Nama Pasien No. SEP Total Tarif Tarif RS Ceklist RS Ceklist BPJS
1 11 Jan 2019 185266 RONERY PANGODIAN CRISTOPER 0117R0760119V001821 3,176,200 12,587,502 √
2 11 Jan 2019 233318 KUNARTI GATOT 0117R0760119V001876 2,954,900 7,203,352 √
3 11 Jan 2019 193690 HARUN 0117R0760119V002354 35,675,200 54,167,853 √
4 11 Jan 2019 233421 NUNUNG 0117R0760119V002369 5,824,800 23,940,325 √
5 11 Jan 2019 231089 NOFIAR NAFIS 0117R0760119V002690 8,837,900 20,489,512 √
6 11 Jan 2019 233510 SITI ROSIAH 0117R0760119V002695 10,214,100 22,684,921 √
7 11 Jan 2019 12678 MEVY FEBRINA 0117R0760119V002710 5,984,100 12,603,099 √
8 11 Jan 2019 103720 MARISA MELINDA 0117R0760119V002820 5,984,100 17,794,340 √
9 11 Jan 2019 233563 BY. NY SRI SOPIAH/HAIKAL YUSU 0117R0760119V002915 2,507,900 4,054,289 √
10 11 Jan 2019 233580 R ASRONO 0117R0760119V002952 58,821,400 64,599,960 √
11 11 Jan 2019 66569 DEVI DWITASARI 0117R0760119V002977 2,722,500 2,798,369 √
12 11 Jan 2019 233603 AISYAH NURUL ILMI 0117R0760119V002985 4,481,300 4,151,749 √
13 11 Jan 2019 233612 BY NY FENITA 0117R0760119V002986 6,217,100 6,870,041 √
14 11 Jan 2019 233616 MERINA 0117R0760119V002996 2,376,200 3,368,733 √
15 11 Jan 2019 15087 JULIUS DARMAWAN 0117R0760119V003265 3,855,500 6,875,664 √
16 11 Jan 2019 17384 RINA ELFITA 0117R0760119V003458 2,722,500 3,293,608 √
17 11 Jan 2019 233132 RIZKY AKBAR FIRANSYAH 0117R0760119V003461 3,841,100 2,350,591 √
18 11 Jan 2019 164662 DUDY ABDURRAHMAN 0117R0760119V003471 58,821,400 70,667,011 √
19 11 Jan 2019 227583 PONTAS ANGGA H 0117R0760119V003485 45,079,800 39,451,299 √
20 11 Jan 2019 222292 SIH KINANTI 0117R0760119V003569 4,101,100 11,943,323 √
21 11 Jan 2019 231075 LILIS ASMANAH 0117R0760119V003581 6,370,000 13,843,677 √
22 11 Jan 2019 56623 ALAM TAHTAWI NASUTION 0117R0760119V003592 8,640,200 13,710,810 √
23 11 Jan 2019 233519 HADIJAH 0117R0760119V003755 6,077,700 5,912,033 √
24 11 Jan 2019 186342 DADANG SUPRIYATNA 0117R0760119V003763 10,690,500 22,249,349 √
25 11 Jan 2019 210472 RUMIYATI 0117R0760119V003809 5,208,600 23,172,271 √
26 11 Jan 2019 224012 DJAJUSMAN 0117R0760119V003818 12,472,300 13,325,151 √
27 11 Jan 2019 232518 PUJI LESTARI CIPTANINGSIH 0117R0760119V003889 6,370,000 2,972,649 √
28 11 Jan 2019 134368 RINA MARYANI 0117R0760119V003913 2,009,900 5,724,947 √
29 11 Jan 2019 85576 YUNIA MAGDALENA 0117R0760119V003916 17,095,200 14,355,269 √
30 11 Jan 2019 226922 WILIS SAPUTRA 0117R0760119V003922 8,908,800 18,907,063 √
31 11 Jan 2019 113904 WAHYU MULYANINGSIH 0117R0760119V003924 5,208,600 24,266,338 √
32 11 Jan 2019 233666 BY NY MARISA MELINDA S 0117R0760119V003926 4,386,800 510,284 √
33 11 Jan 2019 69580 RASYA MAULIDINAROS 0117R0760119V004262 2,722,500 1,749,087 √
34 11 Jan 2019 231078 M. ABIDIN 0117R0760119V004277 6,370,000 6,368,986 √
35 11 Jan 2019 233653 BY NY MEVY FEBRINA 0117R0760119V004305 4,386,800 510,284 √
36 11 Jan 2019 233863 UDI JUNAEDI 0117R0760119V004308 3,587,300 3,677,109 √
Total 384,704,300 563,150,848
Kode RS: 3201230
LAPORAN REKAP KLAIM - RS SENTRA MEDIKA CIBINONG
Pasien Rawat Inap dan Rawat Jalan, Periode Tanggal Pulang: 12 Jan 2019 s/d 12 Jan 2019
No. Tgl. Pulang No. RM Nama Pasien No. SEP Total Tarif Tarif RS Ceklist RS
1 12 Jan 2019 232722 BY NY MAYA ROSSITA SARI 0117R0760119V000378 12,286,000 25,571,951 √
2 12 Jan 2019 110815 H RAMEAN SITOMPUL 0117R0760119V001570 17,977,700 52,112,798 √
3 12 Jan 2019 183278 MILATUL HANIFAH 0117R0760119V002485 6,262,900 5,913,005 √
4 12 Jan 2019 233511 FEBRIAN PUTRA ERLANGGA 0117R0760119V002809 4,481,300 4,995,999 √
5 12 Jan 2019 232876 HADI SOENOTO 0117R0760119V003069 7,684,500 12,628,278 √
6 12 Jan 2019 45623 EMA RESI MUAJA 0117R0760119V003290 9,019,700 23,462,954 √
7 12 Jan 2019 228995 MARIANTO 0117R0760119V003296 9,855,000 37,001,319 √
8 12 Jan 2019 33251 YULIANTI 0117R0760119V003467 2,722,500 3,949,626 √
9 12 Jan 2019 22508 SUSANA KARSIJEM 0117R0760119V003802 4,946,400 4,604,413 √
10 12 Jan 2019 194139 RIMA OCTAVINA CAROLINA 0117R0760119V003817 2,722,500 2,805,492 √
11 12 Jan 2019 232882 DEWI 0117R0760119V003912 45,079,800 41,607,892 √
12 12 Jan 2019 233741 BAYI NYONYA DEWI SEPTIAWATI/SABINA P0117R0760119V003933 5,886,000 2,655,035 √
13 12 Jan 2019 233831 THIO KWITAN ARIFIN 0117R0760119V004263 8,908,800 18,700,077 √
14 12 Jan 2019 210352 VALENTINO 0117R0760119V004421 8,877,800 16,310,196 √
15 12 Jan 2019 93807 EKA ARISTO 0117R0761218V007509 16,892,300 178,998,233 √
Total 163,603,200 431,317,268
Kode RS: 3201230
Ceklist BPJS
LAPORAN REKAP KLAIM - RS SENTRA MEDIKA CIBINONG
Pasien Rawat Inap dan Rawat Jalan, Periode Tanggal Pulang: 13 Jan 2019 s/d 13 Jan 2019
No. Tgl. Pulang No. RM Nama Pasien No. SEP Total Tarif Tarif RS Ceklist RS Ceklist BPJS
1 13 Jan 2019 233296 RUSNADI 0117R0760119V001837 43,018,400 102,582,485 √
2 13 Jan 2019 233499 DANY SATRIO 0117R0760119V002482 5,424,200 23,211,638 √
3 13 Jan 2019 9659 ERNA PUJI LESTARI 0117R0760119V002973 3,176,200 9,899,387 √
4 13 Jan 2019 117130 KARTINI 0117R0760119V003255 3,990,000 5,422,058 √
5 13 Jan 2019 233700 ANNASSA SAHILLA SUNANDAR 0117R0760119V003463 3,841,100 5,364,004 √
6 13 Jan 2019 173161 YULIANI 0117R0760119V003798 9,888,000 4,080,947 √
7 13 Jan 2019 212875 SISKA NOFI ARIYANTI 0117R0760119V003813 6,981,500 20,906,025 √
8 13 Jan 2019 233729 RAZAN ATYA J 0117R0760119V003832 2,061,500 3,641,687 √
9 13 Jan 2019 233793 BILQIS NUR ANISA 0117R0760119V003920 3,304,700 2,846,949 √
10 13 Jan 2019 233796 ARSILA DZAKIRAT UNAJAT AS'SIDQI 0117R0760119V003934 3,695,000 4,177,001 √
11 13 Jan 2019 233803 MUHAMMAD ANDRIANSYAH 0117R0760119V003940 12,140,800 16,778,938 √
12 13 Jan 2019 160490 ANI OKTAVIANA 0117R0760119V003950 3,035,600 2,716,643 √
13 13 Jan 2019 233813 ZAENAL 0117R0760119V004009 29,135,800 28,513,572 √
14 13 Jan 2019 233434 SUDIRMAN 0117R0760119V004015 58,821,400 55,599,343 √
15 13 Jan 2019 227327 TUTY HANDAYANI 0117R0760119V004038 6,535,800 10,918,355 √
16 13 Jan 2019 233038 A.H.M YUSUF 0117R0760119V004126 12,472,300 25,001,995 √
17 13 Jan 2019 214563 NANI MULYANI 0117R0760119V004168 4,340,500 19,147,410 √
18 13 Jan 2019 232175 ACHMAD.S. KOM 0117R0760119V004261 12,472,300 15,138,513 √
19 13 Jan 2019 233830 MARLINAH 0117R0760119V004271 8,908,800 19,288,310 √
20 13 Jan 2019 179013 DENDI 0117R0760119V004321 7,464,200 17,137,370 √
21 13 Jan 2019 233040 DIDIK ADI PRAYITNO , IR 0117R0760119V004344 12,472,300 24,898,825 √
22 13 Jan 2019 125243 SULAEMAN 0117R0760119V004518 4,340,500 20,728,840 √
23 13 Jan 2019 223954 YANTI SUPRIYANTI 0117R0760119V004519 4,340,500 20,122,180 √
24 13 Jan 2019 231453 NANI SURYANI 0117R0760119V004523 4,340,500 20,213,779 √
25 13 Jan 2019 25301 JAENAL AHMAD 0117R0760119V004529 4,340,500 20,233,543 √
26 13 Jan 2019 193588 ZAHEDI 0117R0760119V004541 6,076,700 27,902,735 √
27 13 Jan 2019 107057 TUYEM 0117R0760119V004545 5,208,600 23,606,716 √
28 13 Jan 2019 225731 TJIAUW YAN GIOK 0117R0760119V004548 6,076,700 27,438,231 √
29 13 Jan 2019 191693 ROBBY NATAJAYA 0117R0760119V004554 5,208,600 23,817,394 √
30 13 Jan 2019 205601 ANA SUSILAWATI 0117R0760119V004559 5,208,600 24,102,975 √
31 13 Jan 2019 151159 SUMIYATI 0117R0760119V004560 5,208,600 23,943,573 √
32 13 Jan 2019 233180 MUHTAR 0117R0760119V004569 8,908,800 18,909,556 √
33 13 Jan 2019 233924 NANA HERYANA 0117R0760119V004586 10,690,500 22,295,651 √
34 13 Jan 2019 233926 NINING SURMI 0117R0760119V004589 8,908,800 18,790,312 √
35 13 Jan 2019 223473 SITI PATIMAH 0117R0760119V004591 12,472,300 13,185,381 √
36 13 Jan 2019 214033 SITI SAPUROH 0117R0760119V004592 10,690,500 11,508,053 √
37 13 Jan 2019 233937 AINUL INAYAH 0117R0760119V004593 10,690,500 22,258,791 √
38 13 Jan 2019 233921 SITI FATIMAH 0117R0760119V004605 4,340,500 18,831,408 √
39 13 Jan 2019 162090 SUTINAH 0117R0760119V004606 5,208,600 23,279,124 √
40 13 Jan 2019 221869 M. JAMAT,SPDI 0117R0760119V004621 23,198,900 11,441,487 √
41 13 Jan 2019 226251 BUHERMAN 0117R0760119V004630 19,332,400 20,246,609 √
42 13 Jan 2019 230850 HELWANIH 0117R0760119V004685 10,690,500 11,262,559 √
43 13 Jan 2019 234026 SITI KHUMAIROH 0117R0760119V004693 8,929,300 3,626,865 √
44 13 Jan 2019 191175 MAD USIN 0117R0760119V004699 5,208,600 23,526,120 √
45 13 Jan 2019 234053 NUR HIDAYAT 0117R0760119V004713 3,575,600 1,947,779 √
46 13 Jan 2019 222968 BY NY NURUL HIDAYAH / RUMAISHA 0117R0760119V004732 34,963,000 9,665,324 √
47 13 Jan 2019 233809 SHAWN ARKAGALLENDRA MIHARDJA0117R0760119V005061 5,118,000 2,488,361 √
Total 486,457,000 882,644,801
Kode RS: 3201230
LAPORAN REKAP KLAIM - RS SENTRA MEDIKA CIBINONG
Pasien Rawat Inap dan Rawat Jalan, Periode Tanggal Pulang: 14 Jan 2019 s/d 14 Jan 2019
Filter: Metode Pembayaran = Semua / Kelas Rawat = Semua / Severity = Semua / Cara Pulang = Semua / Jenis Tar
No. Tgl. Pulang No. RM Nama Pasien No. SEP Total Tarif Tarif RS Ceklist RS Ceklist BPJS
1 14 Jan 2019 217098 EKAWATI 0117R0760119V001845 4,144,700 31,072,429 √
2 14 Jan 2019 208727 TAZKIYA SASMITA 0117R0760119V002975 1,718,000 4,649,893 √
3 14 Jan 2019 233611 RICKY T MANAWAN 0117R0760119V002980 58,821,400 79,713,836 √
4 14 Jan 2019 230295 MISKUN 0117R0760119V003160 8,837,900 20,359,432 √
5 14 Jan 2019 233670 MEYDA YOHANA 0117R0760119V003433 4,118,600 9,243,566 √
6 14 Jan 2019 138685 HJ. AMINAH 0117R0760119V003450 39,340,700 107,190,919 √
7 14 Jan 2019 92776 SAMSIAH 0117R0760119V003906 9,188,400 8,306,442 √
8 14 Jan 2019 210780 AZHARI 0117R0760119V003929 7,741,900 17,866,182 √
9 14 Jan 2019 179098 AMELIA SHADRINA 0117R0760119V003938 6,981,500 22,274,010 √
10 14 Jan 2019 227181 AZKA RAFFASYA 0117R0760119V003946 2,722,500 4,529,809 √
11 14 Jan 2019 221691 SRI WAHYU WAHDINI 0117R0760119V004358 21,357,400 32,397,339 √
12 14 Jan 2019 233884 DAFFI MORELO AGNAS 0117R0760119V004457 4,626,600 4,573,939 √
13 14 Jan 2019 37252 DARIMIN 0117R0760119V004469 2,722,500 4,476,446 √
14 14 Jan 2019 210341 BY NY ADE IRMA C 0117R0760119V004503 1,743,400 3,258,952 √
15 14 Jan 2019 232826 HESTI MULYAWATI 0117R0760119V004553 7,842,900 17,400,031 √
16 14 Jan 2019 135284 EVI IMPIANI 0117R0760119V004571 3,176,200 4,070,265 √
17 14 Jan 2019 234038 KIMMY VANDELLA ANANDITHA 0117R0760119V004704 3,718,200 2,397,509 √
18 14 Jan 2019 164429 TITI WIDJAYANTI 0117R0760119V004715 2,009,900 5,559,423 √
19 14 Jan 2019 212901 RUMAISA AISYAH MAFAZA 0117R0760119V004723 3,917,900 3,805,276 √
20 14 Jan 2019 199808 DEDI SUPRIATIN 0117R0760119V005154 4,132,100 2,531,169 √
21 14 Jan 2019 233911 BAYI NYONYA AMELIA 0117R0760119V005330 5,118,000 3,435,074 √
22 14 Jan 2019 233875 VELENZA VELIRIA 0117R0760119V005374 3,841,100 4,453,562 √
Total 207,821,800 393,565,503
Kode RS: 3201230
LAPORAN REKAP KLAIM - RS SENTRA MEDIKA CIBINONG
Pasien Rawat Inap dan Rawat Jalan, Periode Tanggal Pulang: 15 Jan 2019 s/d 15 Jan 2019
No. Tgl. Pulang No. RM Nama Pasien No. SEP Total Tarif Tarif RS Ceklist RS Ceklist BPJS
1 15 Jan 2019 204626 PUDJI RAHARDJO S 0117R0760119V003439 7,219,300 26,606,069 √
2 15 Jan 2019 233664 RIMAULI NAPITUPULU 0117R0760119V003457 8,508,800 36,279,630 √
3 15 Jan 2019 207935 AXEL LEON JUANDA 0117R0760119V003779 3,046,500 4,547,181 √
4 15 Jan 2019 66666 MARIDA TAHYA HARAHAP 0117R0760119V003811 8,291,400 9,149,467 √
5 15 Jan 2019 233795 HAMIZAN ARSHAKA HADI 0117R0760119V003923 3,613,200 6,855,793 √
6 15 Jan 2019 189778 HJ. SITI AMINAH 0117R0760119V003953 7,317,500 11,686,426 √
7 15 Jan 2019 231074 MASRINI 0117R0760119V004123 6,180,400 9,358,780 √
8 15 Jan 2019 176448 YUDI DARMAWAN 0117R0760119V004423 2,925,900 6,792,737 √
9 15 Jan 2019 205103 AL FATHIR SAKHA A 0117R0760119V004532 9,649,200 18,923,367 √
10 15 Jan 2019 126813 ELIN SOLINA 0117R0760119V004581 3,841,100 4,401,227 √
11 15 Jan 2019 233969 RANAA RIMARSYA HAAZIMA 0117R0760119V004598 3,841,100 4,508,503 √
12 15 Jan 2019 233626 ABDURAHMAN RAMADAN 0117R0760119V004603 2,925,900 6,908,882 √
13 15 Jan 2019 11841 YEDI MARYADI 0117R0760119V004706 7,293,200 9,751,908 √
14 15 Jan 2019 227588 SUNSUDIN 0117R0760119V004751 46,734,600 55,885,042 √
15 15 Jan 2019 40536 SISWI SRI UTAMI 0117R0760119V004764 1,896,900 1,436,421 √
16 15 Jan 2019 111022 KOMARIAH 0117R0760119V004882 9,150,100 8,434,516 √
17 15 Jan 2019 227680 ISTIK ARYANINGSIH 0117R0760119V004886 6,370,000 13,737,192 √
18 15 Jan 2019 226118 AHMAD DARURI 0117R0760119V004896 41,590,500 45,909,864 √
19 15 Jan 2019 73506 SATRIYANI 0117R0760119V004924 12,218,600 6,204,256 √
20 15 Jan 2019 152833 ROSWATI 0117R0760119V004929 46,734,600 46,667,373 √
21 15 Jan 2019 202322 BY NY PUTRI UTAMI N/ANNISA HANA 0117R0760119V005110 3,167,100 1,948,622 √
22 15 Jan 2019 232968 SUTARNA 0117R0760119V005176 7,464,200 9,946,551 √
23 15 Jan 2019 233800 BY NY RINA 0117R0760119V005376 4,386,800 6,589,053 √
24 15 Jan 2019 139359 DEDI WIATI S.SOS 0117R0760119V005523 6,077,700 4,573,267 √
Total 260,444,600 357,102,127
Kode RS: 3201230
LAPORAN REKAP KLAIM - RS SENTRA MEDIKA CIBINONG
Pasien Rawat Inap dan Rawat Jalan, Periode Tanggal Pulang: 16 Jan 2019 s/d 16 Jan 2019
No. Tgl. Pulang No. RM Nama Pasien No. SEP Total Tarif Tarif RS Ceklist RS Ceklist BPJS
1 16 Jan 2019 233543 EROH MAESAROH 0117R0760119V002762 11,481,700 30,294,425 √
2 16 Jan 2019 233487 KARMITA 0117R0760119V002807 16,277,100 19,179,376 √
3 16 Jan 2019 233585 ANDRIA NOVA 0117R0760119V002969 4,425,400 11,405,615 √
4 16 Jan 2019 126390 SARYATI 0117R0760119V003306 6,023,100 13,927,052 √
5 16 Jan 2019 108928 YULITA 0117R0760119V004728 12,391,500 16,075,490 √
6 16 Jan 2019 93885 MARITZA ALTHAFUNNISA 0117R0760119V004731 2,507,900 2,787,242 √
7 16 Jan 2019 103679 CECELIA FEBRISTA 0117R0760119V004743 4,481,300 5,966,108 √
8 16 Jan 2019 65843 RAZIANA ZEBUA 0117R0760119V004746 6,795,600 18,788,635 √
9 16 Jan 2019 234078 BOY ALFAUZI 0117R0760119V004747 10,406,400 18,176,903 √
10 16 Jan 2019 234084 RUDY RENWARIN 0117R0760119V004758 41,590,500 56,468,949 √
11 16 Jan 2019 201147 ODAH 0117R0760119V004928 9,584,600 19,124,254 √
12 16 Jan 2019 230566 TRI RAHARJO 0117R0760119V005022 15,255,300 13,701,548 √
13 16 Jan 2019 234061 CALON BY NY TITI WIDJAYANTI 0117R0760119V005171 5,203,800 5,579,207 √
14 16 Jan 2019 234161 SHAQIRA ALESHA AYUDIA NARDIAND 0117R0760119V005205 4,481,300 3,293,766 √
15 16 Jan 2019 234179 MUHAMMAD LABIEB MALIKUL MULKY 0117R0760119V005255 7,808,800 3,127,682 √
16 16 Jan 2019 39614 DINI YASIARMI 0117R0760119V005267 2,722,500 2,713,465 √
17 16 Jan 2019 31961 TUGIYAH 0117R0760119V005345 8,877,800 13,739,054 √
18 16 Jan 2019 233229 ENDANG RISWANDA 0117R0760119V005360 8,877,800 13,604,420 √
19 16 Jan 2019 18703 IRSAAD NOOR ADDIN 0117R0760119V005373 2,722,500 2,567,541 √
20 16 Jan 2019 234225 PHO TJE TJAI 0117R0760119V005391 4,052,100 3,205,359 √
21 16 Jan 2019 229254 ETI RUSTIATI 0117R0760119V005392 2,925,900 3,730,824 √
22 16 Jan 2019 130128 H. IYOD SIROJUDIN 0117R0760119V005452 6,852,200 4,831,701 √
23 16 Jan 2019 234258 ROSAD 0117R0760119V005690 4,340,500 19,165,003 √
24 16 Jan 2019 234289 UBA SAUT NADEAK 0117R0760119V005758 8,908,800 18,848,255 √
Total 208,994,400 320,301,874
Kode RS: 3201230
LAPORAN REKAP KLAIM - RS SENTRA MEDIKA CIBINONG
Pasien Rawat Inap dan Rawat Jalan, Periode Tanggal Pulang: 17 Jan 2019 s/d 17 Jan 2019
No. Tgl. Pulang No. RM Nama Pasien No. SEP Total Tarif Tarif RS Ceklist RS Ceklist BPJS
1 17 Jan 2019 186491 AGUS SUHAENUDIN 0117R0760119V003616 14,058,300 25,465,511 √
2 17 Jan 2019 200732 TIGRISBONATUA 0117R0760119V003947 3,734,400 12,747,286 √
3 17 Jan 2019 233918 FADLI AGUNG NUGROHO 0117R0760119V004478 3,841,100 8,880,610 √
4 17 Jan 2019 213742 SITI FATIMAH AZ ZAHRA 0117R0760119V004661 5,058,500 8,530,610 √
5 17 Jan 2019 143446 SYAHLAN IDRIS 0117R0760119V004697 10,107,000 22,637,456 √
6 17 Jan 2019 234043 ALKAFKA DEFALIANO SYAQI 0117R0760119V004702 2,507,900 5,192,430 √
7 17 Jan 2019 234060 ILHAM SYAHWANDI 0117R0760119V004717 5,045,200 6,135,936 √
8 17 Jan 2019 209538 RIFQIE NADIM UKAIL 0117R0760119V004762 4,335,900 5,018,823 √
9 17 Jan 2019 218325 SARIPUDIN R.M 0117R0760119V004779 4,431,500 4,507,795 √
10 17 Jan 2019 19393 ERLINA PURI 0117R0760119V004985 9,649,200 23,199,665 √
11 17 Jan 2019 120948 NARENDRA RABBANI ARYASATYA0117R0760119V005264 3,855,500 3,626,860 √
12 17 Jan 2019 66709 SYAKHIRAJAINIAULIA 0117R0760119V005372 2,507,900 2,752,679 √
13 17 Jan 2019 234222 RR ANISA FISQIYA M 0117R0760119V005386 3,841,100 4,357,995 √
14 17 Jan 2019 234243 ADTYA SURYA PRATAMA 0117R0760119V005607 4,655,000 7,786,700 √
15 17 Jan 2019 234266 AGUNG SUGIARTO 0117R0760119V005666 3,176,200 3,218,467 √
16 17 Jan 2019 18030 FITRI YANDINI H L 0117R0760119V005688 6,486,300 19,311,953 √
17 17 Jan 2019 146073 ATIKAH 0117R0760119V005697 19,332,400 10,181,227 √
18 17 Jan 2019 234252 ALZAM FAIZ BASHIRA 0117R0760119V005871 2,538,800 2,884,041 √
19 17 Jan 2019 226190 DUMASIH HUTAHURUK 0117R0760119V005872 1,743,400 9,207,412 √
20 17 Jan 2019 24810 LAILA AKHDIANTI 0117R0760119V005877 2,722,500 2,893,517 √
21 17 Jan 2019 234331 RADITYA ANGGARA 0117R0760119V005881 4,425,900 12,871,537 √
22 17 Jan 2019 193224 ADHYASTA BINTANG RAMADHAN 0117R0760119V005882 2,405,100 2,782,456 √
23 17 Jan 2019 230118 AULIA NISA WIRAWAN 0117R0760119V005965 6,397,900 8,634,194 √
24 17 Jan 2019 227428 RICHARDUS TRISBIANTARA 0117R0760119V006017 41,590,500 45,312,890 √
25 17 Jan 2019 223699 MUDJIATI 0117R0760119V006050 51,950,600 48,032,708 √
26 17 Jan 2019 226720 IDA FANIDA 0117R0760119V006054 41,590,500 44,552,930 √
27 17 Jan 2019 70532 ANDI SOPYAN 0117R0760119V006089 4,101,100 12,721,156 √
28 17 Jan 2019 227701 MARYATI 0117R0760119V006124 45,079,800 39,735,460 √
29 17 Jan 2019 227461 MULYATI 0117R0760119V006155 36,446,400 40,670,700 √
30 17 Jan 2019 234295 BAYI NYONYA YANDINI HERILIE 0117R0760119V006296 4,386,800 1,231,094 √
31 17 Jan 2019 233839 JAYA JAKA D 0117R0760119V006334 6,341,300 11,710,273 √
32 17 Jan 2019 228692 CECEP JAENUDIN 0117R0760119V006351 14,653,000 13,053,116 √
33 17 Jan 2019 234163 TATI 0117R0760119V006363 6,341,300 10,608,581 √
34 17 Jan 2019 86335 DESWITA MAHARANY 0117R0760119V006379 2,655,900 2,837,013 √
35 17 Jan 2019 204867 WARSIH 0117R0760119V006387 27,065,300 24,024,967 √
36 17 Jan 2019 234370 SAMLAWI 0117R0760119V006390 4,340,500 18,767,982 √
37 17 Jan 2019 186513 HJ JUROH 0117R0760119V006391 23,198,900 22,202,772 √
Total 436,598,900 548,286,802
Kode RS: 3201230
LAPORAN REKAP KLAIM - RS SENTRA MEDIKA CIBINONG
Pasien Rawat Inap dan Rawat Jalan, Periode Tanggal Pulang: 18 Jan 2019 s/d 18 Jan 2019
No. Tgl. Pulang No. RM Nama Pasien No. SEP Total Tarif Tarif RS Ceklist RS Ceklist BPJS
1 18 Jan 2019 106880 TATANG SUTRISNA 0117R0760119V000534 8,556,600 103,649,973 √
2 18 Jan 2019 197780 RONY DOLFIAN 0117R0760119V001692 92,864,200 76,829,716 √
3 18 Jan 2019 187816 ARSYILA ANGGUN W 0117R0760119V003477 11,481,700 30,615,759 √
4 18 Jan 2019 44515 LUTHFI TSAQIF A 0117R0760119V004708 2,507,900 5,572,545 √
5 18 Jan 2019 155486 MARTHIN HUYAJULU 0117R0760119V005106 2,507,900 5,780,042 √
6 18 Jan 2019 230479 NUR FATIMAH 0117R0760119V005361 3,688,800 3,449,297 √
7 18 Jan 2019 234193 NGATIYEM 0117R0760119V005368 4,435,100 14,909,023 √
8 18 Jan 2019 234197 ILHAM WAKHID AZIZY 0117R0760119V005371 10,879,400 9,254,382 √
9 18 Jan 2019 116790 ASHIELA LOVENIA PUTRI 0117R0760119V005389 3,167,100 3,735,415 √
10 18 Jan 2019 232884 WAHYUNINGSIH 0117R0760119V005613 21,357,400 25,708,302 √
11 18 Jan 2019 133055 H. ODANG 0117R0760119V005719 19,168,100 13,708,071 √
12 18 Jan 2019 234316 PRANTIKA OCTAVIANI 0117R0760119V005865 2,033,900 5,203,601 √
13 18 Jan 2019 167355 YOSEFINA KALASANSIA 0117R0760119V005870 2,925,900 4,957,777 √
14 18 Jan 2019 234327 NADHIRA FATIMAH NAZHWA 0117R0760119V005874 2,722,500 3,334,648 √
15 18 Jan 2019 156984 ROSALIA DOMINIQUE DB 0117R0760119V005934 3,695,000 3,316,895 √
16 18 Jan 2019 232678 ASWATI 0117R0760119V006003 7,842,900 16,610,474 √
17 18 Jan 2019 77599 BARRA ZAIDAN 0117R0760119V006140 2,947,400 8,785,492 √
18 18 Jan 2019 21739 WAHYU SETIYANTO 0117R0760119V006174 2,722,500 3,943,165 √
19 18 Jan 2019 10635 SUSI MILIAWATI 0117R0760119V006228 3,176,200 4,414,913 √
20 18 Jan 2019 234408 YUNINGSIH 0117R0760119V006322 2,538,700 7,109,234 √
21 18 Jan 2019 152029 NAWIYAH 0117R0760119V006380 3,089,800 5,775,608 √
22 18 Jan 2019 232775 MUGIASIH 0117R0760119V006389 12,472,300 13,760,305 √
23 18 Jan 2019 233625 JAMARI 0117R0760119V006394 4,340,500 18,894,497 √
24 18 Jan 2019 234450 HELTI HARYANI HARDI 0117R0760119V006398 34,963,000 18,857,604 √
25 18 Jan 2019 86950 FIRMAN ARDIANSYAH 0117R0760119V006530 3,543,000 8,712,127 √
26 18 Jan 2019 8706 H KOSIRIN KOSIM 0117R0760119V006691 17,095,200 14,975,171 √
27 18 Jan 2019 233922 AMI 0117R0760119V006697 19,332,400 18,267,516 √
28 18 Jan 2019 227087 GUSPARIYAH 0117R0760119V006778 4,958,500 10,971,289 √
29 18 Jan 2019 221216 DR. JANUAR PRIBADI NOKO 0117R0760119V006792 5,784,900 11,834,635 √
30 18 Jan 2019 226740 DELI YARNIS 0117R0760119V006834 5,308,400 1,797,706 √
31 18 Jan 2019 233064 DJAMSARI 0117R0760119V006845 6,370,000 2,912,185 √
32 18 Jan 2019 208489 DIDI SUPRIADI 0117R0760119V006880 12,210,800 12,257,948 √
33 18 Jan 2019 233944 MUHDORI SUMARDANI 0117R0760119V007134 23,198,900 11,775,659 √
Total 363,886,900 501,680,974
Kode RS: 3201230
LAPORAN REKAP KLAIM - RS SENTRA MEDIKA CIBINONG
Pasien Rawat Inap dan Rawat Jalan, Periode Tanggal Pulang: 19 Jan 2019 s/d 19 Jan 2019
No. Tgl. Pulang No. RM Nama Pasien No. SEP Total Tarif Tarif RS Ceklist RS Ceklist BPJS
1 19 Jan 2019 208546 RITA YULIANTY 0117R0760119V002239 6,719,000 13,639,161 √
2 19 Jan 2019 233372 SRI WIRATMI 0117R0760119V002245 31,589,200 120,640,399 √
3 19 Jan 2019 233916 TJUGITO MARSUDI 0117R0760119V004465 8,555,800 22,499,259 √
4 19 Jan 2019 234087 BAHRUM 0117R0760119V005125 20,136,900 50,055,159 √
5 19 Jan 2019 234209 EDWIN ALDRIN FIRMANSYAH 0117R0760119V005380 4,973,600 24,625,856 √
6 19 Jan 2019 227616 ENI KUSTIYAH 0117R0760119V005381 5,022,200 15,760,367 √
7 19 Jan 2019 234229 RAFIF FAQIHUDDIN 0117R0760119V005589 5,886,000 7,491,863 √
8 19 Jan 2019 51582 RINI YUNIASIH NUR SA'IDAH 0117R0760119V005693 4,481,300 6,882,409 √
9 19 Jan 2019 77546 ANDIAN PANJAITAN 0117R0760119V005696 2,722,500 9,332,204 √
10 19 Jan 2019 124424 YETTY USMAN 0117R0760119V005717 9,494,200 14,882,741 √
11 19 Jan 2019 210472 RUMIYATI 0117R0760119V005828 3,976,600 8,154,268 √
12 19 Jan 2019 100654 ENOI WARIAH 0117R0760119V005854 6,852,200 6,287,552 √
13 19 Jan 2019 231153 CUT FARRA DIBA 0117R0760119V005867 7,464,200 24,521,238 √
14 19 Jan 2019 234336 ALMAIRA KHANZA WIJAYA 0117R0760119V005879 2,507,900 3,989,047 √
15 19 Jan 2019 234337 CALISTA ALEXANDRA 0117R0760119V005890 6,624,600 15,968,698 √
16 19 Jan 2019 128143 KARTINI MANURUNG 0117R0760119V005895 7,221,000 8,834,372 √
17 19 Jan 2019 196742 SITI NURMALA L TOBING 0117R0760119V006064 3,432,200 5,109,757 √
18 19 Jan 2019 227573 YANTI SA'DIAH HAMID 0117R0760119V006142 3,874,400 10,756,013 √
19 19 Jan 2019 218934 GAVIN ILHAM BINTARA 0117R0760119V006229 4,335,900 3,373,828 √
20 19 Jan 2019 229848 MAYA SHOPA 0117R0760119V006403 5,984,100 17,352,971 √
21 19 Jan 2019 163181 DJIE KIM KIT 0117R0760119V006506 4,784,600 21,040,527 √
22 19 Jan 2019 227394 LIM TIANG MING 0117R0760119V006512 7,987,100 16,670,184 √
23 19 Jan 2019 181509 BANGKIT DWI UTOMO 0117R0760119V006616 8,773,000 10,009,097 √
24 19 Jan 2019 233333 LUSI HERAWATI NAINGGOLAN 0117R0760119V006637 4,340,500 18,538,616 √
25 19 Jan 2019 234358 IIN APRIYANTI 0117R0760119V006713 8,908,800 18,264,311 √
26 19 Jan 2019 190757 MUHAMMAD KHALIF A 0117R0760119V006745 2,376,200 2,479,420 √
27 19 Jan 2019 76435 MARDIAH BINTI EMAN 0117R0760119V006750 6,076,700 15,238,076 √
28 19 Jan 2019 191871 TRI HASTARI 0117R0760119V006753 8,908,800 21,409,723 √
29 19 Jan 2019 225318 GANI JULIYANTO 0117R0760119V006755 28,247,300 29,760,680 √
30 19 Jan 2019 213843 ENDANG JULIARTINI 0117R0760119V006771 27,065,300 13,992,930 √
31 19 Jan 2019 234459 SITI NURAINI 0117R0760119V006790 8,908,800 10,824,191 √
32 19 Jan 2019 234544 FADHIL GIBRANT DZULFAQQR ALI 0117R0760119V006882 2,925,900 3,174,403 √
33 19 Jan 2019 57296 JESSICA EVANGELIN 0117R0760119V007018 6,041,900 15,990,245 √
34 19 Jan 2019 181816 SUBAIYAH 0117R0760119V007079 51,950,600 46,353,049 √
35 19 Jan 2019 234565 ERNAWATI 0117R0760119V007146 8,908,800 18,759,734 √
36 19 Jan 2019 234473 MARDI SURYANTO 0117R0760119V007180 10,690,500 10,648,285 √
37 19 Jan 2019 234582 MUHAMMAD NUR 0117R0760119V007215 27,065,300 13,612,631 √
38 19 Jan 2019 220516 MUCH HENI FUDJI 0117R0760119V007217 10,690,500 10,688,346 √
39 19 Jan 2019 234622 SITI ROPIQOH 0117R0760119V007306 14,653,000 12,233,943 √
40 19 Jan 2019 233538 SEPTYAN EKO PURWOKO 0117R0760119V007312 17,095,200 13,949,850 √
41 19 Jan 2019 11482 ANGELINUS ROMAWANTO, DK 0117R0760119V007314 8,877,800 14,864,192 √
Total 427,130,400 728,659,595
Kode RS: 3201230
LAPORAN REKAP KLAIM - RS SENTRA MEDIKA CIBINONG
Pasien Rawat Inap dan Rawat Jalan, Periode Tanggal Pulang: 20 Jan 2019 s/d 20 Jan 2019
No. Tgl. Pulang No. RM Nama Pasien No. SEP Total Tarif Tarif RS Ceklist RS Ceklist BPJS
1 20 Jan 2019 7413 CLARISSA PUTRI WIBOWO 0117R0760119V005123 2,090,000 9,327,215 √
2 20 Jan 2019 232604 ARGO SUBAGIYONO 0117R0760119V005663 9,855,000 26,247,724 √
3 20 Jan 2019 41560 SITI RUSTINI 0117R0760119V005803 9,673,300 9,768,045 √
4 20 Jan 2019 230132 HERU IRANTO 0117R0760119V006105 7,039,300 18,632,761 √
5 20 Jan 2019 232436 ANDISA YANI 0117R0760119V006481 3,874,400 9,176,185 √
6 20 Jan 2019 234371 ENDANG KUSDIANA 0117R0760119V006810 2,124,500 6,507,310 √
7 20 Jan 2019 234521 NAOMI CHRIESTY 0117R0760119V006844 2,987,000 3,518,969 √
8 20 Jan 2019 197170 BY NY NUR FITRIANA ANGGERAENI(N 0117R0760119V006873 2,871,200 3,727,290 √
9 20 Jan 2019 233376 NURAINI 0117R0760119V006961 21,357,400 21,382,849 √
10 20 Jan 2019 234549 UGAN SUGANDA 0117R0760119V007026 41,590,500 51,611,464 √
11 20 Jan 2019 234583 ELGIO JUNIAR RAMADHAN 0117R0760119V007105 2,507,900 2,104,540 √
12 20 Jan 2019 218233 SARNO K PRAWIRO 0117R0760119V007321 5,660,000 3,330,087 √
13 20 Jan 2019 151169 KAMIRUL HENDRA,SH 0117R0760119V007329 40,790,100 23,322,195 √
14 20 Jan 2019 150999 AISYAH 0117R0760119V007387 23,198,900 24,256,859 √
15 20 Jan 2019 233773 BURHAN 0117R0760119V007403 3,536,800 10,892,358 √
16 20 Jan 2019 229218 ABDUL ROID 0117R0760119V007425 6,076,700 36,424,417 √
17 20 Jan 2019 234670 SETYA NINGSIH KUSUMA WIGATI 0117R0760119V007428 40,790,100 18,085,910 √
Total 226,023,100 278,316,178
Kode RS: 3201230
LAPORAN REKAP KLAIM - RS SENTRA MEDIKA CIBINONG
Pasien Rawat Inap dan Rawat Jalan, Periode Tanggal Pulang: 21 Jan 2019 s/d 21 Jan 2019
No. Tgl. Pulang No. RM Nama Pasien No. SEP Total Tarif Tarif RS Ceklist RS Ceklist BPJS
1 21 Jan 2019 234221 BAYI NY NURMALA SARI 0117R0760119V005644 48,201,900 39,203,006 √
2 21 Jan 2019 234074 SUPRAPTO 0117R0760119V006382 8,663,100 21,601,840 √
3 21 Jan 2019 187947 TOTO SUSENO 0117R0760119V006383 8,987,600 25,504,690 √
4 21 Jan 2019 233611 RICKY T MANAWAN 0117R0760119V006402 9,856,000 19,699,436 √
5 21 Jan 2019 234496 KHANZA AQILA EL D 0117R0760119V006715 2,507,900 14,404,481 √
6 21 Jan 2019 234593 DIONSYA GANIWATI 0117R0760119V007145 4,894,400 5,102,126 √
7 21 Jan 2019 178729 PIPIT FERIANTI 0117R0760119V007192 6,981,500 15,281,213 √
8 21 Jan 2019 231458 ARIYANI 0117R0760119V007286 16,356,600 29,973,700 √
9 21 Jan 2019 131825 KEISYA FARAS A 0117R0760119V007322 2,722,500 3,395,767 √
10 21 Jan 2019 46213 MUHAMMAD NURIZ REZA F 0117R0760119V007324 3,841,100 3,465,399 √
11 21 Jan 2019 65102 REYNARD BERLY R 0117R0760119V007335 4,758,000 3,228,667 √
12 21 Jan 2019 234760 CINDY SAWITRI 0117R0760119V007525 7,715,900 6,853,434 √
13 21 Jan 2019 232803 HENDRA HAKIM 0117R0760119V007556 7,609,600 13,251,185 √
14 21 Jan 2019 125740 ISMAIL FATHONI 0117R0760119V007566 6,077,700 7,593,826 √
15 21 Jan 2019 34513 ZANNE SHARRA PUTRY SAPATUNDAI 0117R0760119V007824 4,481,300 3,784,313 √
16 21 Jan 2019 234643 BAYI NYONYA PIPIT FERIANTI 0117R0760119V007899 5,118,000 964,600 √
Total 148,773,100 213,307,683
Kode RS: 3201230
LAPORAN REKAP KLAIM - RS SENTRA MEDIKA CIBINONG
Pasien Rawat Inap dan Rawat Jalan, Periode Tanggal Pulang: 22 Jan 2019 s/d 22 Jan 2019
No. Tgl. Pulang No. RM Nama Pasien No. SEP Total Tarif Tarif RS Ceklist RS Ceklist BPJS
1 22 Jan 2019 210532 SRI SUNARTI 0117R0760119V005646 7,515,400 8,097,465 √
2 22 Jan 2019 234329 SUMINAH 0117R0760119V005876 43,006,200 61,789,347 √
3 22 Jan 2019 234451 YENIH BT. MAMI 0117R0760119V006400 14,562,700 29,539,605 √
4 22 Jan 2019 232085 TRI MALIA 0117R0760119V006872 11,740,200 13,971,835 √
5 22 Jan 2019 91468 NINIK WIJAYANTI 0117R0760119V007140 5,005,900 6,351,500 √
6 22 Jan 2019 234608 RAHMAT NUR ALAM 0117R0760119V007316 1,452,800 3,159,077 √
7 22 Jan 2019 234644 JAYADI SAPRI.HS 0117R0760119V007332 40,790,100 35,680,270 √
8 22 Jan 2019 234646 MUHAMMAD SALIM HUSAIN 0117R0760119V007368 2,405,100 3,981,253 √
9 22 Jan 2019 231770 RIZKI RAPASYA R 0117R0760119V007385 9,649,200 18,841,269 √
10 22 Jan 2019 190495 ALMAHYRA FEYZA SHAKILA 0117R0760119V007513 3,176,200 4,992,965 √
11 22 Jan 2019 234745 RUSMINAH 0117R0760119V007520 10,326,200 13,966,055 √
12 22 Jan 2019 234792 ARYA NAVARRO ALGHIFAHRI 0117R0760119V007561 2,507,900 1,868,664 √
13 22 Jan 2019 137045 IRFAN SHURI 0117R0760119V007571 3,393,400 3,721,620 √
14 22 Jan 2019 231772 SRI SOETOJO 0117R0760119V007694 58,821,400 46,943,016 √
15 22 Jan 2019 231919 MASDAN 0117R0760119V007707 51,950,600 44,430,388 √
16 22 Jan 2019 231895 TRI PRIYO SISWANTO 0117R0760119V007717 41,590,500 46,911,443 √
17 22 Jan 2019 112070 MARTI RUBIYANTI 0117R0760119V007846 58,821,400 45,809,423 √
18 22 Jan 2019 234239 ALLBAQAFI ODANG 0117R0760119V007890 6,041,900 10,656,170 √
19 22 Jan 2019 133425 AGUS MUSLIM 0117R0760119V007898 4,958,500 3,667,870 √
20 22 Jan 2019 161386 SHELLA THENNIA 0117R0760119V007920 2,009,900 7,597,282 √
21 22 Jan 2019 233520 RONALD TOMASOA 0117R0760119V007927 27,065,300 24,240,760 √
22 22 Jan 2019 234832 IPAH 0117R0760119V007932 19,332,400 19,397,623 √
23 22 Jan 2019 234825 MUANI 0117R0760119V007933 19,332,400 18,791,438 √
24 22 Jan 2019 162090 SUTINAH 0117R0760119V008003 4,958,500 3,202,703 √
25 22 Jan 2019 232593 MIKHAEL KAMI 0117R0760119V008064 4,958,500 3,955,994 √
26 22 Jan 2019 145020 ALITA WULAN DINI 0117R0760119V008104 2,775,400 4,455,082 √
27 22 Jan 2019 124559 IFAN 0117R0760119V008108 5,784,900 3,860,817 √
28 22 Jan 2019 234927 ADIS SYAHRIL YUZA 0117R0760119V008306 2,639,300 1,153,304 √
29 22 Jan 2019 234020 SYAFRI DEWI 0117R0760119V008387 3,857,000 1,469,663 √
Total 470,429,200 492,503,901
Kode RS: 3201230
LAPORAN REKAP KLAIM - RS SENTRA MEDIKA CIBINONG
Pasien Rawat Inap dan Rawat Jalan, Periode Tanggal Pulang: 23 Jan 2019 s/d 23 Jan 2019
No. Tgl. Pulang No. RM Nama Pasien No. SEP Total Tarif Tarif RS Ceklist RS Ceklist BPJS
1 23 Jan 2019 169903 RENTA HOTMARIA BUTAR BUTAR 0117R0760119V005241 5,045,200 9,717,656 √
2 23 Jan 2019 233987 NAURA SALSABILA 0117R0760119V005243 40,790,100 42,112,163 √
3 23 Jan 2019 232666 ANGKY TIAWAN 0117R0760119V005325 6,217,100 11,252,227 √
4 23 Jan 2019 141863 H. SYAMSUL RIZAL 0117R0760119V006207 16,780,800 24,999,391 √
5 23 Jan 2019 230309 NURAINI 0117R0760119V006386 12,046,700 12,478,262 √
6 23 Jan 2019 234509 MUHAMMAD FIRDAUS AL-KAHFI 0117R0760119V006758 4,481,300 11,789,620 √
7 23 Jan 2019 231965 ANDRIYASARI 0117R0760119V007304 2,753,900 6,368,241 √
8 23 Jan 2019 234763 ADE CHAIRUL UMAM 0117R0760119V007530 3,200,900 4,653,953 √
9 23 Jan 2019 234768 NAURA AF 0117R0760119V007532 6,379,000 12,431,573 √
10 23 Jan 2019 230678 MUHAMMAD AYDIN ZAFRAN /BY NY NU 0117R0760119V007564 16,208,300 17,482,398 √
11 23 Jan 2019 233998 SHINTHIA NOVIYANTI 0117R0760119V007778 10,406,400 12,945,825 √
12 23 Jan 2019 234820 DZAKAN T SAQIB 0117R0760119V007812 2,925,900 2,395,445 √
13 23 Jan 2019 234765 DEO IKSAN PRASETYA 0117R0760119V007843 2,925,900 5,512,818 √
14 23 Jan 2019 71997 REYNALDO ALEXANDER 0117R0760119V007866 2,033,900 3,983,569 √
15 23 Jan 2019 232162 SIPA NURAENI 0117R0760119V007888 8,264,200 10,842,296 √
16 23 Jan 2019 234777 SALAM 0117R0760119V007931 4,181,800 6,897,588 √
17 23 Jan 2019 234830 MELISA 0117R0760119V007955 29,135,800 9,008,597 √
18 23 Jan 2019 189952 MOERINDRA WAHYUDI PERMANA 0117R0760119V008311 58,821,400 49,492,817 √
19 23 Jan 2019 233854 PARTI 0117R0760119V008340 12,218,600 5,714,898 √
20 23 Jan 2019 234790 EDY HERMAWAN 0117R0760119V008388 9,584,600 22,585,845 √
21 23 Jan 2019 234959 N MULYATI 0117R0760119V008422 12,472,300 23,929,031 √
22 23 Jan 2019 235005 NANDANG MIJI ANGGORO 0117R0760119V008553 3,584,400 2,951,403 √
23 23 Jan 2019 232705 AHMAD R 0117R0760119V008566 45,079,800 44,217,968 √
24 23 Jan 2019 119957 AGUS SALIM 0117R0760119V008569 51,950,600 56,435,246 √
25 23 Jan 2019 235000 ELMY 0117R0760119V008575 5,208,600 24,263,566 √
26 23 Jan 2019 201154 ERIYADI 0117R0760119V009044 4,202,600 2,144,088 √
Total 376,900,100 436,606,484
Kode RS: 3201230
LAPORAN REKAP KLAIM - RS SENTRA MEDIKA CIBINONG
Pasien Rawat Inap dan Rawat Jalan, Periode Tanggal Pulang: 24 Jan 2019 s/d 24 Jan 2019
No. Tgl. Pulang No. RM Nama Pasien No. SEP Total Tarif Tarif RS Ceklist RS Ceklist BPJS
1 24 Jan 2019 220227 FABIOLA FLORA SAROINSONG 0117R0760119V004752 34,963,000 65,128,590 √
2 24 Jan 2019 63750 DESI SANTOSO 0117R0760119V007290 4,626,600 9,483,440 √
3 24 Jan 2019 232007 EKA SRI WAHYUNINGSIH 0117R0760119V007379 7,842,900 20,050,098 √
4 24 Jan 2019 234772 M. RYAN AZMI M 0117R0760119V007540 13,696,900 15,379,411 √
5 24 Jan 2019 64300 HESTY RAHAYU 0117R0760119V007544 2,941,900 6,500,291 √
6 24 Jan 2019 193460 TIO AURANI HUTAPEA 0117R0760119V007563 3,304,700 3,481,926 √
7 24 Jan 2019 234798 SULISNAENI 0117R0760119V007573 4,481,300 5,412,966 √
8 24 Jan 2019 234785 SAMARA 0117R0760119V007887 3,176,200 5,263,780 √
9 24 Jan 2019 90089 SENNY YULIA PUTRI 0117R0760119V007945 3,176,200 4,927,677 √
10 24 Jan 2019 234890 M. RIZAL 0117R0760119V008076 4,204,300 4,259,524 √
11 24 Jan 2019 45746 KHEIRUNISA DESKIA 0117R0760119V008086 2,722,500 3,327,174 √
12 24 Jan 2019 234914 GERTUDIS SRI MARTINAH 0117R0760119V008103 29,135,800 27,387,421 √
13 24 Jan 2019 50573 YOGI OKTAVIAN 0117R0760119V008692 6,397,900 9,429,020 √
14 24 Jan 2019 224076 SARJU WINATA, DRS 0117R0760119V008726 51,950,600 41,313,020 √
15 24 Jan 2019 228607 CINGTO 0117R0760119V008760 36,446,400 41,307,129 √
16 24 Jan 2019 226375 SUWARDI 0117R0760119V008777 51,950,600 46,434,117 √
17 24 Jan 2019 122791 H SAID 0117R0760119V008795 36,446,400 41,716,165 √
18 24 Jan 2019 234519 IIS SUTIANAH 0117R0760119V008842 27,065,300 23,626,613 √
19 24 Jan 2019 235049 YEYET 0117R0760119V008861 19,332,400 9,818,489 √
20 24 Jan 2019 217976 SOPIAH 0117R0760119V008865 27,065,300 23,967,509 √
21 24 Jan 2019 235035 IHAT FATIHAT 0117R0760119V008867 27,065,300 24,007,473 √
22 24 Jan 2019 235036 ASAH 0117R0760119V008868 19,332,400 18,753,754 √
23 24 Jan 2019 203890 ENDAH 0117R0760119V008870 19,332,400 18,749,424 √
24 24 Jan 2019 216460 KHODIJAH 0117R0760119V008903 23,198,900 11,398,464 √
25 24 Jan 2019 233690 ANDHIKA CANDRA DINATA 0117R0760119V008935 5,331,600 8,693,937 √
26 24 Jan 2019 83831 N.M TUTY KUSUMAWATI 0117R0760119V009046 4,958,500 3,372,017 √
27 24 Jan 2019 121550 TRI YULIANI 0117R0760119V009062 2,760,700 7,242,334 √
28 24 Jan 2019 226476 MAEMUNAH 0117R0760119V009317 58,821,400 49,870,120 √
Total 531,728,400 550,301,883
Kode RS: 3201230
LAPORAN REKAP KLAIM - RS SENTRA MEDIKA CIBINONG
Pasien Rawat Inap dan Rawat Jalan, Periode Tanggal Pulang: 25 Jan 2019 s/d 25 Jan 2019
No. Tgl. Pulang No. RM Nama Pasien No. SEP Total Tarif Tarif RS Ceklist RS Ceklist BPJS
1 25 Jan 2019 40842 PARSIH 0117R0760119V004682 8,781,000 45,535,812 √
2 25 Jan 2019 232008 ISMA YARLINA 0117R0760119V006716 9,150,100 24,411,610 √
3 25 Jan 2019 232508 PERI FIRDAUS 0117R0760119V007394 13,691,500 48,057,395 √
4 25 Jan 2019 213589 YUNUS 0117R0760119V007548 10,605,500 21,647,478 √
5 25 Jan 2019 138786 UMAR ABDUL AZIZ 0117R0760119V007555 3,176,200 8,602,159 √
6 25 Jan 2019 198750 MAEMUNAH 0117R0760119V007719 7,842,900 20,938,456 √
7 25 Jan 2019 232833 MAMUN 0117R0760119V007762 8,837,900 18,020,152 √
8 25 Jan 2019 149157 ENDANG S 0117R0760119V007868 5,873,300 11,874,823 √
9 25 Jan 2019 233576 YATI SURYATINAH 0117R0760119V007893 10,244,500 9,160,188 √
10 25 Jan 2019 77005 SAIFUL AMRI 0117R0760119V008105 5,784,900 21,191,466 √
11 25 Jan 2019 234254 HARI IRAWAN 0117R0760119V008206 7,145,100 11,656,955 √
12 25 Jan 2019 223699 MUDJIATI 0117R0760119V008252 7,515,400 6,425,310 √
13 25 Jan 2019 234952 HENDRI FITRIADI 0117R0760119V008372 3,841,100 4,158,864 √
14 25 Jan 2019 160263 AGUNG SEPTIAN 0117R0760119V008397 5,879,800 10,194,094 √
15 25 Jan 2019 21292 NONG VICTOR TOMBO 0117R0760119V008406 4,655,000 5,905,781 √
16 25 Jan 2019 234935 DIDIK PRASETIYO 0117R0760119V008435 17,361,200 5,319,230 √
17 25 Jan 2019 228674 NAUFAL ADYA FAIRSUKI 0117R0760119V008524 3,176,200 4,288,821 √
18 25 Jan 2019 231540 SHAKIRA OKTAVIANI 0117R0760119V008567 5,489,000 12,145,633 √
19 25 Jan 2019 231888 MUHAMAD WAWAN SAEPULOH 0117R0760119V008574 5,045,200 3,004,793 √
20 25 Jan 2019 75370 AARON YURASLAV NUEVO LUBIS 0117R0760119V008580 2,225,900 2,298,811 √
21 25 Jan 2019 55435 ANNA MARIANA SITORUS 0117R0760119V008784 3,035,600 2,363,626 √
22 25 Jan 2019 17497 SITI MUSLIKHAH 0117R0760119V008845 14,609,500 15,312,942 √
23 25 Jan 2019 4017 LOIDE BUTAR BUTAR 0117R0760119V009017 14,653,000 13,943,284 √
24 25 Jan 2019 235127 ACHMAD FIRDAUS 0117R0760119V009043 51,950,600 38,852,668 √
25 25 Jan 2019 146073 ATIKAH 0117R0760119V009056 20,176,600 21,203,367 √
26 25 Jan 2019 235043 HOERUDIN 0117R0760119V009065 19,332,400 18,894,105 √
27 25 Jan 2019 224012 DJAJUSMAN 0117R0760119V009070 6,076,700 24,726,226 √
28 25 Jan 2019 216682 BOY ISHAK 0117R0760119V009092 46,734,600 51,960,236 √
29 25 Jan 2019 228698 MARIA MAGDALENA 0117R0760119V009183 12,472,300 28,074,111 √
30 25 Jan 2019 233226 SETA KARLINA 0117R0760119V009192 6,370,000 14,071,088 √
31 25 Jan 2019 211672 SUNARTI 0117R0760119V009197 7,431,700 15,500,131 √
32 25 Jan 2019 233237 DESY RAHAYU 0117R0760119V009221 5,308,400 12,158,503 √
33 25 Jan 2019 234016 LILIK SUGIARTI 0117R0760119V009222 6,370,000 14,397,141 √
34 25 Jan 2019 180580 ARSHAD HANZUL A 0117R0760119V009245 4,680,900 10,384,250 √
35 25 Jan 2019 231761 GADIZA AZZAHRA S 0117R0760119V009313 4,680,900 9,984,992 √
36 25 Jan 2019 210472 RUMIYATI 0117R0760119V009359 5,208,600 23,996,694 √
37 25 Jan 2019 76435 MARDIAH BINTI EMAN 0117R0760119V009361 12,472,300 24,268,814 √
38 25 Jan 2019 193544 ROZANA FITRIANI 0117R0760119V009386 2,344,900 12,430,639 √
39 25 Jan 2019 198051 MUHIDIN 0117R0760119V009513 4,340,500 20,377,614 √
40 25 Jan 2019 231714 GOUW HOK GOAN 0117R0760119V009550 14,653,000 12,528,387 √
41 25 Jan 2019 200341 ELIA SOFIANI 0117R0760119V009551 27,065,300 24,037,045 √
Total 436,289,500 704,303,694
Kode RS: 3201230
LAPORAN REKAP KLAIM - RS SENTRA MEDIKA CIBINONG
Pasien Rawat Inap dan Rawat Jalan, Periode Tanggal Pulang: 26 Jan 2019 s/d 26 Jan 2019
No. Tgl. Pulang No. RM Nama Pasien No. SEP Total Tarif Tarif RS Ceklist RS Ceklist BPJS
1 26 Jan 2019 234709 KASIJAH 0117R0760119V007499 8,364,500 35,526,884 √
2 26 Jan 2019 171240 TUMINEM 0117R0760119V007565 43,006,200 62,613,415 √
3 26 Jan 2019 234316 PRANTIKA OCTAVIANI 0117R0760119V008068 5,739,000 16,039,082 √
4 26 Jan 2019 71613 DJIYONO 0117R0760119V008106 17,797,100 27,411,505 √
5 26 Jan 2019 234662 PURDIANA SARI 0117R0760119V008224 6,397,900 27,216,106 √
6 26 Jan 2019 234989 UDIN. S 0117R0760119V008572 19,332,400 37,739,535 √
7 26 Jan 2019 32178 MAINI 0117R0760119V008682 7,464,200 19,841,525 √
8 26 Jan 2019 127787 MARYATI 0117R0760119V008813 8,448,000 13,587,159 √
9 26 Jan 2019 101839 SIONY NURSANI 0117R0760119V008848 9,855,000 22,509,291 √
10 26 Jan 2019 155978 MIMIN 0117R0760119V008909 6,586,700 17,140,731 √
11 26 Jan 2019 64130 ICHWAN ALIMUN HAKIM 0117R0760119V008912 5,824,800 10,003,055 √
12 26 Jan 2019 208935 BY NY MELDA 0117R0760119V008913 2,655,900 2,617,317 √
13 26 Jan 2019 130982 S NURHASANAH 0117R0760119V009006 7,842,900 14,679,520 √
14 26 Jan 2019 18137 EPRILLAH SANDY 0117R0760119V009007 6,981,500 16,634,849 √
15 26 Jan 2019 127355 SRI NURHAYATI 0117R0760119V009041 1,743,400 4,019,440 √
16 26 Jan 2019 235128 ADIBA SHAKILLA H 0117R0760119V009060 2,405,100 4,088,285 √
17 26 Jan 2019 195288 ADREENA ERWINSYAH 0117R0760119V009152 2,405,100 2,990,421 √
18 26 Jan 2019 126481 RATU ANDINI 0117R0760119V009352 2,655,900 3,304,241 √
19 26 Jan 2019 234994 YAHYA 0117R0760119V009357 8,908,800 40,094,355 √
20 26 Jan 2019 235159 BACO ACHMAD 0117R0760119V009385 2,987,000 3,015,604 √
21 26 Jan 2019 169716 CECEP RIYANDI 0117R0760119V009413 5,824,800 12,554,203 √
22 26 Jan 2019 226251 BUHERMAN 0117R0760119V009427 3,293,700 5,979,639 √
23 26 Jan 2019 14853 SELAMET RIANTI 0117R0760119V009536 3,734,400 5,456,757 √
24 26 Jan 2019 220626 TULUS SINAGA 0117R0760119V009549 7,609,600 12,941,001 √
25 26 Jan 2019 199489 MULYONO 0117R0760119V009650 7,229,800 10,516,368 √
26 26 Jan 2019 235094 JAMIATUL FITRIA 0117R0760119V009679 51,950,600 47,920,752 √
27 26 Jan 2019 225867 NURDIN 0117R0760119V009714 34,354,000 26,015,608 √
28 26 Jan 2019 234473 MARDI SURYANTO 0117R0760119V009747 10,690,500 21,974,864 √
29 26 Jan 2019 232233 JUNAENAH 0117R0760119V009800 9,783,500 13,203,754 √
30 26 Jan 2019 234582 MUHAMMAD NUR 0117R0760119V009808 27,065,300 23,999,208 √
31 26 Jan 2019 235108 FOE KIE TJONG 0117R0760119V009830 58,821,400 47,368,805 √
32 26 Jan 2019 235266 TATI RATNANINGSIH HJ 0117R0760119V009831 12,472,300 23,975,632 √
33 26 Jan 2019 235268 ANTON 0117R0760119V009835 8,908,800 18,739,573 √
34 26 Jan 2019 235149 AYI JULIANA 0117R0760119V009873 27,065,300 23,337,229 √
35 26 Jan 2019 235193 DIYONO 0117R0760119V009877 23,198,900 21,425,784 √
36 26 Jan 2019 233874 H M ISHAK ISMAIL 0117R0760119V009948 8,877,800 13,309,764 √
37 26 Jan 2019 233885 RM ERWAN HERYAWAN 0117R0760119V009992 12,210,800 10,993,639 √
38 26 Jan 2019 233083 DEDI CHANDRA 0117R0760119V010027 4,540,900 11,743,758 √
39 26 Jan 2019 234280 MISTO 0117R0760119V010028 5,883,600 1,529,089 √
40 26 Jan 2019 234933 SUPARNO 0117R0760119V010033 23,198,900 11,681,799 √
41 26 Jan 2019 235157 BY NY EPRILAH SANDY 0117R0760119V010037 5,118,000 1,284,084 √
42 26 Jan 2019 95958 SUBEKTI 0117R0760119V010059 5,013,100 4,957,113 √
43 26 Jan 2019 235337 RIMBUN SINAGA 0117R0760119V010162 6,970,400 5,656,380 √
44 26 Jan 2019 235293 KYLA RYAN AZ-ZAHRA 0117R0760119V010625 4,204,300 3,431,479 √
45 26 Jan 2019 235151 BAYHAKI 0117R0760119V010686 5,208,600 21,730,658 √
Total 550,630,700 782,799,260
Kode RS: 3201230
LAPORAN REKAP KLAIM - RS SENTRA MEDIKA CIBINONG
Pasien Rawat Inap dan Rawat Jalan, Periode Tanggal Pulang: 27 Jan 2019 s/d 27 Jan 2019
No. Tgl. Pulang No. RM Nama Pasien No. SEP Total Tarif Tarif RS Ceklist RS Ceklist BPJS
1 27 Jan 2019 234394 INDARTI 0117R0760119V008416 6,488,600 8,142,465 √
2 27 Jan 2019 234980 ADINDA SAFIRA 0117R0760119V008439 3,965,700 6,253,259 √
3 27 Jan 2019 91646 BUDIMAN TJAHAYADI PRIBADI 0117R0760119V008889 5,850,400 18,647,060 √
4 27 Jan 2019 235104 DWI CATUR PRAKOSO 0117R0760119V008962 2,507,900 4,423,549 √
5 27 Jan 2019 190764 WYNONA YOCELINE 0117R0760119V009002 2,061,500 5,707,898 √
6 27 Jan 2019 203529 FRENDY JUDIKA SINAGA 0117R0760119V009059 2,925,900 4,059,061 √
7 27 Jan 2019 235133 ANI ARIYANI 0117R0760119V009069 6,488,600 5,026,455 √
8 27 Jan 2019 176892 CHINTIA MELY LUSIANI 0117R0760119V009450 4,986,800 19,534,495 √
9 27 Jan 2019 235210 DONNA MEI SARRO 0117R0760119V009546 3,841,100 4,271,617 √
10 27 Jan 2019 161655 FRANSISCA NOVIANTI PANADI 0117R0760119V009897 3,035,600 2,846,750 √
11 27 Jan 2019 234885 BY NY SHELLA THENNIA 0117R0760119V009983 4,386,800 2,666,298 √
12 27 Jan 2019 235324 HARYADI 0117R0760119V010041 2,925,900 4,132,706 √
13 27 Jan 2019 209272 NIA RAHMAN KUSUMAWATI 0117R0760119V010098 5,178,700 12,414,944 √
14 27 Jan 2019 233399 LISNAWATI KARLISNA 0117R0760119V010101 7,464,200 9,893,840 √
15 27 Jan 2019 203338 HERMAWAN 0117R0760119V010113 6,076,700 28,754,736 √
16 27 Jan 2019 215680 J MARBUN 0117R0760119V010118 5,208,600 24,013,290 √
17 27 Jan 2019 235257 UNTUNG BASUKI 0117R0760119V010150 4,958,500 3,570,102 √
18 27 Jan 2019 228698 MARIA MAGDALENA 0117R0760119V010151 5,784,900 3,388,449 √
19 27 Jan 2019 1173 BUNGAWATI LIMBONG 0117R0760119V010165 2,033,900 2,862,713 √
20 27 Jan 2019 235388 DADANG 0117R0760119V010173 19,332,400 18,918,749 √
21 27 Jan 2019 235354 ROJALI 0117R0760119V010180 19,332,400 10,050,772 √
22 27 Jan 2019 235360 SAUNAH 0117R0760119V010182 8,908,800 19,434,472 √
23 27 Jan 2019 235348 ROYANI SAPUTRA 0117R0760119V010189 5,208,600 11,643,626 √
24 27 Jan 2019 235359 MUSLIHAT 0117R0760119V010190 4,340,500 18,740,656 √
25 27 Jan 2019 235141 ALI 0117R0760119V010244 4,958,500 3,898,835 √
Total 148,251,500 253,296,797
Kode RS: 3201230
LAPORAN REKAP KLAIM - RS SENTRA MEDIKA CIBINONG
Pasien Rawat Inap dan Rawat Jalan, Periode Tanggal Pulang: 28 Jan 2019 s/d 28 Jan 2019
No. Tgl. Pulang No. RM Nama Pasien No. SEP Total Tarif Tarif RS Ceklist RS Ceklist BPJS
1 28 Jan 2019 158634 U SUTISNA 0117R0760119V005122 48,095,600 107,784,834 √
2 28 Jan 2019 230038 IIS DASMAWATI 0117R0760119V008562 39,340,700 63,550,117 √
3 28 Jan 2019 185508 MIMI ARYANI SIREGAR 0117R0760119V008568 35,675,200 54,173,318 √
4 28 Jan 2019 183733 MAZELIA PAULUS 0117R0760119V009558 2,722,500 4,715,048 √
5 28 Jan 2019 184570 RINDIKA SAFITRI 0117R0760119V009559 2,722,500 4,950,117 √
6 28 Jan 2019 63035 UTORO 0117R0760119V009684 5,178,700 14,239,078 √
7 28 Jan 2019 172932 ALIF RASYIDI 0117R0760119V009984 8,115,800 5,339,020 √
8 28 Jan 2019 194206 MOHAMAD RAFLI 0117R0760119V010024 5,045,200 2,368,858 √
9 28 Jan 2019 235296 NGAMI 0117R0760119V010038 1,452,800 3,599,650 √
10 28 Jan 2019 226681 NASYA DEVRIANIE HABIBAH 0117R0760119V010048 3,187,000 4,178,562 √
11 28 Jan 2019 81555 NATHAN HERLIAN 0117R0760119V010057 2,722,500 2,716,501 √
12 28 Jan 2019 73426 CAHAYA PUTRI ANFIRA RIZKY 0117R0760119V010179 3,116,300 3,707,630 √
13 28 Jan 2019 235428 MUHAMMAD NIZAM MAULANA IRHAM 0117R0760119V010268 8,922,900 5,840,982 √
14 28 Jan 2019 25239 FADHIL SYACH R 0117R0760119V010271 2,376,200 1,906,425 √
15 28 Jan 2019 235332 UMAR ABDULLAH AZZAM 0117R0760119V010618 3,718,200 3,338,076 √
Total 172,392,100 282,408,216
Kode RS: 3201230
LAPORAN REKAP KLAIM - RS SENTRA MEDIKA CIBINONG
Pasien Rawat Inap dan Rawat Jalan, Periode Tanggal Pulang: 29 Jan 2019 s/d 29 Jan 2019
No. Tgl. Pulang No. RM Nama Pasien No. SEP Total Tarif Tarif RS Ceklist RS Ceklist BPJS
1 29 Jan 2019 184755 BY NY ELLY/ALMERA KHANZA R 0117R0760119V008583 4,758,000 5,154,227 √
2 29 Jan 2019 234177 SRI WAHYUNI 0117R0760119V008757 9,150,100 24,309,525 √
3 29 Jan 2019 235131 FEDIANSYAH 0117R0760119V009071 4,895,400 13,161,944 √
4 29 Jan 2019 232823 PANJI 0117R0760119V009270 8,685,100 14,875,649 √
5 29 Jan 2019 234410 MAMIH BINTI S 0117R0760119V009402 4,227,600 6,136,749 √
6 29 Jan 2019 90483 SURYADI 0117R0760119V009407 4,426,600 17,613,622 √
7 29 Jan 2019 101381 PURNOMO 0117R0760119V009438 7,040,000 19,657,767 √
8 29 Jan 2019 50399 ARIPIN SADIKIN 0117R0760119V009531 45,079,800 56,654,846 √
9 29 Jan 2019 218017 CHRISTABEL BENNETA ARSTELI0117R0760119V009848 4,335,900 5,109,991 √
10 29 Jan 2019 133605 DESIH SUKAESIH 0117R0760119V010100 9,150,100 14,495,915 √
11 29 Jan 2019 235357 RASMIAH 0117R0760119V010171 4,340,500 19,096,582 √
12 29 Jan 2019 235349 MUSTIKA 0117R0760119V010177 19,332,400 19,756,517 √
13 29 Jan 2019 235440 MENTARI SUCI 0117R0760119V010274 2,722,500 3,145,654 √
14 29 Jan 2019 208160 MUHAMMAD REYZA FIRDAUS 0117R0760119V010279 2,722,500 3,466,691 √
15 29 Jan 2019 235444 BY NY SARAH DYAS KARISMA 0117R0760119V010281 4,562,400 5,728,575 √
16 29 Jan 2019 189438 ALVIN GHAISAN ALTAMIS 0117R0760119V010285 2,507,900 2,522,909 √
17 29 Jan 2019 197405 REYHAN ARGYA WIJAYA 0117R0760119V010287 2,061,500 2,554,472 √
18 29 Jan 2019 235480 FAZRIL CANDRA WIGUNA 0117R0760119V010316 2,925,900 3,285,656 √
19 29 Jan 2019 231449 ENTONG 0117R0760119V010318 36,446,400 41,067,625 √
20 29 Jan 2019 93807 EKA ARISTO 0117R0760119V010323 2,961,900 6,484,520 √
21 29 Jan 2019 15607 DJUMADI 0117R0760119V010338 40,790,100 38,766,583 √
22 29 Jan 2019 235497 SITI ASIYAH 0117R0760119V010409 2,405,100 2,160,196 √
23 29 Jan 2019 217086 UDIN 0117R0760119V010477 14,653,000 13,955,738 √
24 29 Jan 2019 86483 ELIYA ZUMILAH 0117R0760119V010479 3,900,700 9,188,229 √
25 29 Jan 2019 207388 REIFAN RANGGA ARIFANSYAH 0117R0760119V010617 12,096,300 16,205,960 √
26 29 Jan 2019 232762 NOMI 0117R0760119V010633 8,908,800 18,802,288 √
27 29 Jan 2019 235257 UNTUNG BASUKI 0117R0760119V010643 5,208,600 11,417,151 √
28 29 Jan 2019 235514 TB. HARUN 0117R0760119V010644 12,472,300 23,955,849 √
29 29 Jan 2019 233455 TASYA INDRIA AFANDY 0117R0760119V010683 9,150,100 9,277,313 √
30 29 Jan 2019 210559 EVIE YULIA STEVANI 0117R0760119V010698 27,065,300 24,008,508 √
31 29 Jan 2019 230182 SUKARSIH 0117R0760119V010703 10,690,500 21,048,423 √
32 29 Jan 2019 235598 LINDA WIRMALA 0117R0760119V010836 29,135,800 8,345,309 √
33 29 Jan 2019 235531 SITI FATIMAH 0117R0760119V011262 5,176,000 3,794,699 √
Total 363,985,100 485,205,682
Kode RS: 3201230
LAPORAN REKAP KLAIM - RS SENTRA MEDIKA CIBINONG
Pasien Rawat Inap dan Rawat Jalan, Periode Tanggal Pulang: 30 Jan 2019 s/d 30 Jan 2019
No. Tgl. Pulang No. RM Nama Pasien No. SEP Total Tarif Tarif RS Ceklist RS Ceklist BPJS
1 30 Jan 2019 235052 MUHAMAD AKBAR FADILLAH 0117R0760119V008871 7,570,100 25,805,215 √
2 30 Jan 2019 143827 ERIC MAULANA SE 0117R0760119V009387 6,190,600 18,366,273 √
3 30 Jan 2019 119848 FEBRIYANTI S 0117R0760119V009804 13,079,500 43,352,470 √
4 30 Jan 2019 235085 AHMAD ZAKI FIRDAUS 0117R0760119V010300 2,405,100 3,212,100 √
5 30 Jan 2019 235474 MUHAMMAD ALFI ARROSYID 0117R0760119V010305 3,187,000 3,683,458 √
6 30 Jan 2019 235484 FADILAH 0117R0760119V010324 5,984,100 14,048,842 √
7 30 Jan 2019 234398 ENDANG HARGANETI 0117R0760119V010418 7,842,900 14,451,915 √
8 30 Jan 2019 201365 INDRA PERMATA 0117R0760119V010425 9,150,100 15,038,749 √
9 30 Jan 2019 226251 BUHERMAN 0117R0760119V010793 20,176,600 43,678,473 √
10 30 Jan 2019 235197 BAYI NYONYA ROZANA FTIRIANI 0117R0760119V010816 5,118,000 2,640,388 √
11 30 Jan 2019 146747 CICIH 0117R0760119V010832 45,079,800 53,746,687 √
12 30 Jan 2019 235605 DWI KURNIADI 0117R0760119V010841 2,405,100 2,448,952 √
13 30 Jan 2019 58995 RENI JUNIANAH 0117R0760119V010844 1,994,600 1,478,610 √
14 30 Jan 2019 211570 SETIAWAN SUWONDO 0117R0760119V010967 51,950,600 44,908,858 √
15 30 Jan 2019 226520 LEO SURYADI 0117R0760119V011001 58,821,400 47,001,860 √
16 30 Jan 2019 233532 IKA ATIKAH 0117R0760119V011037 11,208,800 19,680,250 √
17 30 Jan 2019 235614 KERI 0117R0760119V011116 12,472,300 24,519,766 √
18 30 Jan 2019 235617 RUSTOMO 0117R0760119V011124 19,332,400 19,173,950 √
19 30 Jan 2019 111186 DESIH S 0117R0760119V011129 15,692,300 20,342,455 √
20 30 Jan 2019 235615 NGADIKAN 0117R0760119V011132 5,208,600 22,183,762 √
21 30 Jan 2019 214988 AKHIRA ZONI 0117R0760119V011161 4,132,100 8,404,683 √
22 30 Jan 2019 232246 DEDEH W H 0117R0760119V011166 15,692,300 21,809,699 √
23 30 Jan 2019 226532 NURYACHTI 0117R0760119V011260 15,692,300 22,188,126 √
24 30 Jan 2019 221229 ATIN 0117R0760119V011299 19,332,400 24,262,649 √
25 30 Jan 2019 235702 SUGIARTO 0117R0760119V011317 2,955,200 6,445,223 √
26 30 Jan 2019 235488 BAYI NYONYA FADILAH 0117R0760119V011630 4,386,800 691,544 √
27 30 Jan 2019 193305 NURUL ZAIRINA 0117R0760119V011723 4,202,600 1,633,742 √
Total 371,263,600 525,198,699
Kode RS: 3201230
LAPORAN REKAP KLAIM - RS SENTRA MEDIKA CIBINONG
Pasien Rawat Inap dan Rawat Jalan, Periode Tanggal Pulang: 31 Jan 2019 s/d 31 Jan 2019
No. Tgl. Pulang No. RM Nama Pasien No. SEP Total Tarif Tarif RS Ceklist RS Ceklist BPJS
1 31 Jan 2019 235196 BAYI NY FARRAH DWI YUNIA 0117R0760119V009548 3,126,000 14,186,523 √
2 31 Jan 2019 117478 MUHAMMAD ZALFA FAIRUZ 0117R0760119V010157 3,965,700 7,604,336 √
3 31 Jan 2019 211224 SUSILA UTAMI 0117R0760119V010158 5,711,300 9,148,576 √
4 31 Jan 2019 221335 ZYAN DARU JOBAN 0117R0760119V010289 4,335,900 7,111,505 √
5 31 Jan 2019 235486 NIKODEMUS JOKO ELBAYU MARANI 0117R0760119V010334 3,176,200 5,305,996 √
6 31 Jan 2019 235494 RAKA MAHESA FAUZAN 0117R0760119V010342 5,045,200 4,161,377 √
7 31 Jan 2019 233456 MIHARJA 0117R0760119V010450 10,605,500 18,054,485 √
8 31 Jan 2019 97636 VENTI 0117R0760119V010636 5,073,100 7,976,108 √
9 31 Jan 2019 235582 MUHAMMAD DHAWY Z 0117R0760119V010808 2,722,500 3,381,638 √
10 31 Jan 2019 177288 ATIKAH RAHMAN 0117R0760119V010838 1,743,400 4,120,015 √
11 31 Jan 2019 235030 FAQIH AKBAR 0117R0760119V011203 4,136,800 14,882,733 √
12 31 Jan 2019 35255 SITI SALASIAH 0117R0760119V011410 51,950,600 46,069,743 √
13 31 Jan 2019 88117 ENDUY BIN H. SAIH 0117R0760119V011531 48,095,600 24,476,979 √
14 31 Jan 2019 235732 MANSYUR H 0117R0760119V011553 34,354,000 27,044,999 √
15 31 Jan 2019 230280 CECEP SAEPULOH 0117R0760119V011596 45,079,800 40,595,736 √
16 31 Jan 2019 217976 SOPIAH 0117R0760119V011633 27,065,300 13,210,241 √
17 31 Jan 2019 235730 AFRILIANA 0117R0760119V011635 12,472,300 25,193,006 √
18 31 Jan 2019 235740 NI KETUT CHANDRA YANTI 0117R0760119V011643 8,908,800 19,349,757 √
19 31 Jan 2019 234940 SRIMARDINAH 0117R0760119V011763 8,877,800 15,419,580 √
20 31 Jan 2019 120750 KUSNO 0117R0760119V011857 6,077,700 2,236,539 √
Total 292,523,500 309,529,872
Kode RS: 3201230

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