rs bmc(1).pdf

7/23/2019 RS BMC(1).pdf

http://slidepdf.com/reader/full/rs-bmc1pdf 1/11

, : : ; i B P J SK es e h a t an.~ ~. B a d an P en y e le n g g ar a J a m in a n So s ia l

Nomor

Lampiran

Hal

: l";)z.. N-02/1115

1 (satu) berkas

Hasil Pemeriksaan Rutin Satuan

Pengawasan Internal (SPI)

Sukabumi, ~O November 2015

Yth. Direktur Bakti Medicare

ditempat

BPJS Kesehatan sebagai lembaga badan hukum publik yang bertanggung jawab

langsung kepada Presiden (vide Pasal 7 Undang-Undang Nomor 24 Tahun 2011 tentang

Badan Penyelenggara Jaminan Sosial), bersama ini menyampaikan terima kasih atas

kerjasama yang telah terjalin selama ini dalam hal Pelayanan kesehatan Peserta JaminanKesehatan Nasional (JKN).

Sehubungan dengan pemeriksaan rutin Satuan Pengawasan Internal (SPI) BPJSKesehatan, dengan ini kami sampaikan sebagai berikut:

A. Hasil Pemeriksaan

1. Ditemukan pembayaran klaim yang tidak sesuai dengan tarif Peraturan menteri

Kesehatan NO.59 Tahun 2014 (Rincian klaim terlampir- Lampiran 1)

2. Ditemukan indikasi kewajiban klaim PT. Jasa Raharja (Persero) sebagai penjamin

pertama program koordinasi manfaat jaminan sosial kecelakaan lalu lintas (Rincianklaim terlampir Lampiran 2)

7/23/2019 RS BMC(1).pdf


B. Permintaan Tindak Lanjut

Atas hasil pemeriksaan tersebut, kami memohon kesediaan manajemen Bakti Medicare

untuk dapat diantaranya:1. Memperkenankan klarifikasi berkas pendukung klaim dan bersama petugas BPJS

Kesehatan berkoordinasi dengan PT. Jasa Raharja (Persero)

2. Melengkapi dokumen administrasi terkait persyaratan yang harus dipenuhi oleh Rumah

Sakit sebagai dasar kredensialing dan Perjanjian Kerja Sama dengan BPJS Kesehatan

3. Memperkenankan klarifikasi berkas pendukung klaim dan melakukan grouping ulang

klaim-klaim dengan kode tindakan tidak sesuai

4. Melakukan pengembalian selisih klaim kepada BPJS Kesehatan Cabang Sukabumi

dengan mekanisme kompensasi pada pembayaran klaim bulan pelayanan berikutnya.

Demikian kami sampaikan, atas perhatian dan kerjasamanya diucapkan terimakasih.

Tembusan, disampaikan kepada Yth:1. Kepala BPJS Kesehatan Divisi Regional Jawa Barat2. Kepala BPJS Kesehatan KLOK Sukabumi

7/23/2019 RS BMC(1).pdf


Lompir;on 1

DI...-._Prlm.r_Sl<u KdKls N mI • • • • . .,

Tlrill*l' ". . . T " "N . NOSJP TGlSJP N " " " ' . N MP ST T GW lR PS T

""" Ta:IOt&SJP TIlPlitSJP KodeDlq KDINACBG NmlntCBG < o o T•••lfRS TlrlfCIlG • • • • • • TIrifIOA PerIMn •..•, P Hl Mn ", S el ls lh

• • • • ,. . ",. • u,u,

" "DIilrr1loea and

NYERIABDOMEN"1 ~~~50914 06/09/2014 0001258044895 DUDIRAHADIAN 09/04/1976 t 06/09/2014 09/09/2014 A09

lj:utroentl!rllis 01I K-4.17-f GASTROENTERITl5 4 2.9S6.700 3.206.410 Sl!hal I 2.475.300 3.206.410 3.206,411 2.475.300 731.110

prl!sumed InfKtlouslAIN-lAIN (RINGAN)

oriDlnOiarr1loea and

NYERIABDOMEN &2 011811.0050914

05/09/2014 0001251554024 HALIMAH 1 2/ 04 /1 95 1 P 0 5/ 09 /2 01 4 08/09/2014 A09lj:astfOl'ntl!ritlsof

, 1(-4.17-1 GASTROENTERlTIS 4 2.825.265 2.290.293 Sl!hat , 1.168.100 2.290.293 2.290.293 1.768.100 522.1930000711 prl!sumed InfectiouslAIN.lAIN [RINGAN)

Dri in

1.253.303

7/23/2019 RS BMC(1).pdf


Lampiran 2

No NOSJP TGLSJP NMPST TGlLHRP5T JKP5T T .l ot .5 JP T .1 Pl .5 JP K od eO la .Ola.nou_Prlmer_5ku KdKlsR

NmlniCBG Tarif RS TarifCBGNmJnsP Kewajiban PT

Selisih KlaimNoKAPst KOINACBG L a,nder wt ulan. Jasa Raharja

1 0118RooS06152 6/ 06 /2 01 5 0 00 03 96 96 96 36 A I Y UN IN G5 1H 0 1/ 04 /1 97 4 P 26/06/2015 27/06/2015 5299

Unspecified injury of 3 M-l.GO.1

MU5KUlO5KlETAL&2 3.265.250 5.341.400 S eh at 3. 26 5.2 50 5.341.400

0002493 thorax JARINGAN

2 0118R0050215Ctush injury other and

MU5KUL05KlETAL &21/02/2015 0001145>48912 ENGKOS KOSASIH 26/06/1991 L 2 1/ 02 /2 01 5 2 4/ 02 /2 01 5 S 6 7 8 u ns pe ci fi ed pa rU o f 2 M.l.60-i 4 5.382.118 6.409.700 Sehat S.382.118 6.409.700

0002350wrist and hand

JARINGAN

3 0118ROO503151 0/ 03 /2 01 5 0 00 11 10 37 37 62 M AS KI YA H 0 5/ 11 /1 97 0 P 10/03/2015 11/03/2015 5299

Unspecified lnjury of 2 M.l.60-i

MU5KUlOSKLETAl &2 4.240.905 5.409.700 S eh at 4 .2 40 .9 05 6.409.700

0001187 thorax JARINGAN

4 0118ROOS0615 Injury of eve and orbil, 3PROSEDUR LENSA

2 1/ 06 /2 01 5 0 00 14 59 32 05 68 A NS OR I 1 1/ 11 /1 96 4 l 21/06/2015 22/06/2015 5OS9 H-l-30.i DAN INTRA OKULER 2 5.085.595 5.518.600 Sehat 5.085.595 5.518.6000001910 unspeclfied

RINGAN

5 0118R0050315Open wound of wrlst

MU5KULOSKLETAL &1 7/ 03 /2 01 5 0 00 03 97 23 91 86 R UD I H AR TO NO 0 1/ 07 /1 97 7 L 1 7/ 03 /2 01 5 1 9/ 03 /2 01 5 S 61 9 a nd h an d p ar t, p ar t 3 M.I-60-i 3 5.000.908 5.341.400 S eh at 5 .0 00 .9 08 5.341.400

0002281unspecified

JARINGAN

29.020.800

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lampiran 3

TglPlgSJPKod.

ProcedureKdKls

Tar if R S Tar if CB G H ilslI Pengujia n B e rkiI sNo NOSJP TGLSJP NoKAPst N MP ST T Gl lHR PST J KP ST Tg lD tg SJP l c ,',ac Rwt

laporan Operasi:

0118RooSI014 Other skin graft to0/ Vulnus Avulsi Pedis Dextra dan 5inlstril terinfeksi

14/10/2014 0001339225672 HASANUDIN 0 5/ 09 /1 97 2 l 1 4/ 10 /2 01 4 1 7/ 10 /2 01 4 8669 2 4 9.812.886 12.536.900 Prosedur: Debridemen1 0000663 other sites

Pada uraian prosedur di laporan operasi tercantum

debridemen dan TIDAKADA GRAFT

2 0118R005091409/09/2014 0001384309438 SUTISNA 0 5/ 10 /1 98 7 l 0 9/ 09 /2 01 4 2 3/ 09 /2 01 4 866'

Other skin graft to2 15 7.273.853 6.966.718 TIdak terlampir laporan operasi pada berkas klaim

0000482 other sites

0118RooS021524/02/2015 0001515839231 REFIANIH 2 2/ 09 /1 98 4 P 2 4/ 02 /2 01 5 26/02/2015 8673

Attachment of pedicle2 3 7.423.473 6.966.700 mohon konfirmasi berkas

3 0002789 or flap graft to hand

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Lampiran 4

NMPST TGLLHRPST TglDtgSJP TglPlgSJPKod. KdKls

T ar if R S T ar if CB G Hasil PenelusuranNo NOSJP T GL 5J P No KA Ps t JKPST

p " " Procedure

Rwt

1 0118RooS0515OOO2068 22/05/2015 0001849828206 jroyatul astriyyah 12/04/2000 P 22/05/2015 23/05/2015 8339Excision of lesion of

3 7.054.320 8.884.200laporan Operasi: Kista Aterom Facialis Sinistra,

other soft tissue Eksisi

2 0118R005061SOOO2383 25/06/2015 0001188242752lElY

26/12/1998 P 25/06/2015 27/06/2015 8339Excision of lesion of

, 9.454.670 10.661.000 Cla•••us Plantar Pedis Dextra, htirpasi NURLAELATUL other soft tissue

3 0118R00504150002831 27/04/2015 0001607162253 NURMALASARI 07/02/1984 P 27/04/2015 29/04/2015 8339Excision of lesion of

, 11.111.285 10.661.000 laporan Operasi: FAM Sinistra 3X4X4 cm, Eksisiother soft tissue

22/05/2015 0000396435936 NYAIMULYATI 01/08/1978 P 22/05/2015 23/05/2015 8339Excision of lesion of

3 2.771.085 4.428.500 laporan Operasi: Papilloma Brachii Dextra,Eksisi4 0118R0050515OOO2141

other soft tissue

50118R0050415OOO2834 27/04/2015 0001180872685 RANIMAELA5ARI 02 /0 5/ 19 86 P 2 7/ 04 /2 01 5 29/04/2015 8339Excision of lesion of ,

8.991.995 10.661.000 Resume Medis: FAM Dextra. laporan Operasi tidak

other soft tissue terlampir pada berkas klaim

6 0118R00504150001229 09/04/2015 0001386345126 SAHATSIHOTANG 16/12/1960 l 09/04/2015 12/04/2015 8339hcision of lesion of ,

12.232.171 5.314.200 Abses Pedis, Exicisiother soft tissue

70118R00505150002114 22/05/2015 0001848926878 SITINURMAYA 14/01/1998 P 22/05/2015 23/05/2015 8339Excision of lesion of

3 8.645.505 8.884.200 laporan Operasi: FAM Dextra, Biopsi Eksisiother soft tissue

8 0118R00504150000870 06/04/2015 0001468499512 TEn HERMAWATI 04/07/1976 P 06/04/2015 08/04/2015 8339Excision of lesion of

3 8.179.865 8.884.200 laporan Operasi: FAM, Biopsi Eksisiother soft tissue

9 0118R0050515OOOO873 09/05/2015 0001410276341 BUDISETIAWAN 13/04/1969 L 09/05/2015 10/05/2015 8339Excision of lesion of , 4.497.630 5.314.200 laporan Operasi: Soft Tissue Tumor Arm ,Eksisiother soft tissue

10 0118R00504150001416 14/04/2015 0001410255696 CATURWIDYANTO 13/11/1977 l 14/04/2015 15/04/2015 8339Excision of lesion of

, 4.352.530 5314.200laporan Operasi: Soft Tissue Tumor Pedis Dextra,


11 0118R005041SOOO2656 24/04/2015 0001462896606 DEDIJAMALUDIN 09/02/1967 l 24/04/2015 25/04/2015 8339Excision of lesjon of

I 4.662.780 5.314.200 laporan Operasi: Soft Tissue Tumor lumbalis , Eksisiother soft tissue

12 0118R00504150001817 17/04/2015 0001462896606 DEDIJAMALUDIN 09/02/1967 L 17/04/2015 18/04/2015 8339Excision of lesion of

, 4.403.810 5.314.200laporan Operasi: Soft Tissue Tumor Humerus

other soft tissue Dextra, Eksisi

13 0118ROO504150000791 07/04/2015 0001326678186HALWANSAPARI

08/06/1997 L 07/04/2015 08/04/2015 8339ExCision of lesion of ,

4.287.075 5.314.200laporan Operasi: 50ft Tissue Tumor Plantar Pedis,

ARIP olher soft tissue Eksisi

0118R00504150001835 17/04/2015 0001156536674 ILHAMBUDIMAN 26/04/1982 l 17/04/2015 18/04/2015 8339Excision of lesion of ,

4.446.730 5.314.200 laporan Operasi: Soft Tissue Tumor Pedis Dextra,14

other soft tissue EkSISI

15 0118R00504150003066 28/04/2015 0001142065315 IMAM NAWAWI 1 4/ 08 /1 98 9 l 2 8/ 04 /2 01 5 29/04/2015 8339Excision of lesion of ,

4.557.820 5.314.200 laporan Operasi: Soft Tissue Tumor Digit! 111Manus

other soft tissue Dextra, Eksisi

16 0118R0050415OOO1484 13/04/2015 0001135998685 M HA581ASIDIe. 29/09/1984 L 13/04/2015 14/04/2015 8339Excision of lesion of

I 5.854.535 5.314.200 laporan Operasi: Soft Tissue Tumor Facial ukuran

other soft tissue 3x2x2 cm, Eksisi

17 0118ROO505150000769 08/05/2015 0001335542602 MIMIN 06/03/1954 P 08/05/2015 09/05/2015 8339Excision of lesion of

3 4.111.840 4.428.500 laporan Operasi: Multiple Soft Tissue Tumor Femur,


18 0118R00505150000148 02/05/2015 0001797350062 NOPIYANTJ 29/11/1983 P 02/05/2015 03/05/2015 8339ExCision of lesion of

I 4.647.090 5.314.200laporan Operasi: mutiple Soft Tissue Tumor

other soft tissue Humerus, Eksisi

0118R0050415OOO2676 23/04/2015 0001315852852 DOM KOMARIAH 08/03/1956 P 23/04/2015 24/04/2015 8339Excision of lesion of

, 7.945.323 10.661.000laporan Operasi: Soft Tissue Tumor Axilla Oextra19

other soft tissue ukuran 5x4x5 cm, Eksisi

04/05/2015 0001463057662 RIOAMSUHENDAR 25/10/1999 l 04/05/2015 05/05/2015 8339Excision of lesion of

3 5.714.020 8.884.200 laporan Operasi: 50ft Tissue Tumor Dada, Eksisi'0 0118R00505150000154other soft tissue

0118R00505150000240 05/05/2015 0001232921171 SOliHAT 27/06/1966 P 05/05/2015 07/05/2015 8339Excision of lesion of

3 9.425.135 8.884.200laporan Operasi: Multiple Soft Tissue Tumor 11

other soft tissue (ranium, Eksisi

0118R00504150001814 17/04/2015 0001469246523 SOPIAN 17/03/1972 L 17/04/2015 18/04/2015 8339ExCiSionof lesion of

3 3.720.105 4.428.500 laporan Operasi: Soft Tissue Tumor Digiti II Manus,

" other soft tissue Eksisi

0118R005051SOOO2116 22/05/2015 0001846711732 TE 5UMAN 03/08/1949 l 22/05/2015 24/05/2015 8339Excision of lesion of

3 8.623.141 8.884.200laporan OperasI: mutiple Soft Tissue Tumor 13

other soft tissue Thoracalis, Eksisi

7/23/2019 RS BMC(1).pdf


24 01l8R0050515lXlOO587 07/05/2015 0001089039745 TATIRAHMAWATI 0 2/ 10 /1 99 1 P 0 7/ 05 /2 01 5 08/05/2015 8339Excision of lesion of

3 8.424.780 4.428.500laporan Operasi: Soft Tissue Tumor Brachlalis

other soft tissue 5inirtra, Eksisi

25 0118R00505150000874 09/05/2015 0001818438996 U. NASRULLAH 1 9/ 05 /1 95 1 l 0 9/ 05 /2 01 5 10/05/2015 8339Excision of Iesion of

2 4.513.500 5.314.200 laporan Operasi: Multiple Soft Tissue Tumor ,Eksisiother soft tissue

26 0118ROO50415OOO1049 10/04/2015 0001256068732 YU U 01/02/1979 P 10/04/2015 11/04/2015 8339Excision of lesion of

2 8.141.135 laporan Operasi: 50ft Tissue Tumor Thoracalis

other soft tissue 10.661.000

Dextra ,Eksisi

27 01l8ROO506150000485 05/06/2015 0000397014096 PATIMAH 0 1/ 07 /1 96 5 P 0 5/ 06 /2 01 5 06/06/2015 8339Excision of lesion of

3 8.697.965 8.884.200 laporan Operasi: 50ft Tissue Tumor 5ubmandibula,


2B 0118ROO5061SOOO1929 22/06/2015 0001471469117 JAYASUNJAYA 1 4/ 12 /1 97 8 l 2 2/ 06 /2 01 5 23/06/2015 8339Excision of Iesion of

3 7.452.385 8.884.200 mohon konfirmasi berkasother soft tissue

7/23/2019 RS BMC(1).pdf


Lampiran 5a

No nosjp nokapst nmpst tgldtgsjp tglplgsjp ByTagSJP NmJnsPel S e li si h Ha si l P en gu ji an B er ka s

1 0118R00511140000389 1337173536 AJAT 07/11/2014 08/11/2014 2.759.600 RITL 7/11/2014 sd 8/11/2014

0118R00511140001658 1337173536 AJAT 0 8/ 11/ 20 14 0 8/ 11 /20 14 1 55.40 0 R JT L 155.400 UGD7/11/2014

2 0118R00505150000970 1290533117 NENGSUCI 07/05/2015 10/05/2015 1.300.500 RITL Tgl Masuk 7/5/2015

0118R00505150003419 1290533117 NENGSUCI 0 7/ 05 /2 01 5 0 7/ 05 /2 01 5 1 55.40 0 R JT L 155.400 Poli Anak; 7/5/2015

3 0118R00506140000125 1299967479 anasya almaira 06/06/2014 12/06/2014 6.215.214 RITL 6/6/2014 sd 12/6/2014

0118R00506140000120 1299967479 anasya almaira 06/06/2014 06/06/2014 238.415 RJTL 238.415

4 0118R00506140000632 1198960356 muhammad 27/06/2014 30/06/2014 10.661.023 RITL

0118ROOS0614000064S 1198960356 muhammad 2 7/ 06/ 20 14 2 7/ 06 /20 14 1 55 .3 72 RJTL 155.372

704.587

lampiran 5b

No nosjp nokapst nmpst tgldtgsjp t gl pl gs jp B yT ag SJ P NmJnsPel Selisih Hasil Pengujian Berkas

1 0118ROOS12140002200 1258443955 EMMYSYARIFAH 19/12/2014 24/12/2014 1.807.800 RITL 19/12/2014 s.d 24/12/2014

0118ROOS12140002068 1258443955 EMMYSYARIFAH 2 4/ 12 /2 01 4 2 4/ 12 /2 014 1 55.40 0 R JT L 155.400 Pol Mata 24/12/2014

2 0118R00503150002308 1454015946 SANTOKUSWOR( 19/03/2015 20/03/2015 1.768.100 RITL 19/3/2015 sd 20/3/2015

0118R005031500023S0 1454015946 SANTOKUSWOR( 20/03/2015 20/03/2015 155. 400 RJTL 155.400 Poli Bedah 20/3/2015

3 0118R00508140000499 1272169653 ABDULSYUKUR,( 17/08/2014 18/08/2014 2.894.229 RITL 17/8/2014 sd 18/8/2014

0118R00508140000694 1272169653 ABDULSYUKUR,( 1 8/ 08 /20 14 1 8/ 08 /2 01 4 1 55.37 2 RJTL 155.372 Berkas belum diterima

466.172

7/23/2019 RS BMC(1).pdf


lampi~n6

NMPPK NoKAPst NMPST TGllHRPST JKPST TIIPIISJPKod. DJalnou_Prlmer kdKls

Nmln,CBGNo NOSJP T GlSJP TIIOtj;SJP01'1 _Sllunder ' M

K01NACBG l o . T ' rI fR S h rl fC 8G H as ll P en lu jl ,n B er ka s

Essential

1 Bakti Medieilre0118R0050814

28/08/2014000006'"

AGUS SOPIAN 09/03/1964 L 28/08/2014 28/08/2014 110 (prirNryl 2 1-4-11-11 HIPERTENSI SEDANG 1 1.210.135BilIini Sist.m 26/8/2014 sd.

4.708.2340001062 4658

hype".nsion 28/8/2014

RSUO R. SAMSUDIN l009ROO10814 27/08/2014 000006158 AGUS SOPIAN 0 9/ 03 /1 96 4 L 2 7/ 08 /2 01 4 0 1/ 09 /2 01 4 I SOO Coniest •••••hurt 3 1-4.12-i KEGAGALANJANTUNG RINGAN , BillinI 5lst.m 27/8/2014 s.d SH 0014184 •• 58 fallure

2.274.962 5.213.1481/9/2014

0118R0051014 000145445 WIOIBurns involvlnl

2 Bakti Medicare 31/10/2014 08/03/2012 P 31/10/2014 08/11/2014 T312 20-29% of body 2 5-4.16-1ii LUKABAKARBERAT 9 5.176.865 6.368.800 8erbs belum diterim,0001601 3m NURfADILAH

surface

R SU O R . S AM SU DI N l 00 9R OO I1 11 4 0 00 14 54 45 wimBurns Involvinl

s.d 15/11/201407/11/2014 08/03/2012 P 07/11/2014 15/11/2014 T312 20-29% of body 2 M-I-50-ii PROSEDUR JARINGAN LUNAKSEDANG 9 14.581.364 12.899.800

SH 0013796 3m NURFADILAHsurface

D/Combutio, Leukositosis,

3 ~:UO R. SAMSUDIN l009Roo10615 000178784 specir ••d iISKECEDERAANPEMBULUH DARAHOTAK

Billinl Sistim: 14/6/201514/06/2015 NANI roh,ni 1 8/ 12 /1 93 9 P 1 4/ 06 /2 01 5 23/06/2015 16' 1 G - 4 '1 5- ii N ON S PE SI FI K & PENYUMBATAN PRE. 10 11.035.185 4.799.200

0008343 3 S 4 1 hnmorrhale or CfREBRAL TANPA INFARKSEDANG

s.d 23/6/2015

0118R0050615 000118784Acute mYOCilrdial

Bakti Medicar. 16/06/20153 S 4 1

NANI rohani 1 8/ 12 /1 93 9 P 1 6/ 06 /2 01 5 1 6/ 06 /2 01 5 1 21 9 i nf am io n, 3 1-4-1Q-l INFARKMYOKARDAKUT RINGAN 1 2.039.280 2.283.200 Berkas belum diterima0003134

unspeciffed

7/23/2019 RS BMC(1).pdf


l a m p ir a n 7

No n m p p k nosJp no kapst nm p st tgld tgs jp tglplgsjp B v Ta g SJ P N m Jn s Pe l H a si l P en g u ji an B e rk as

1 Bakt i Medicare 0118R00501150002790 1800827921 IMA MULDANIYAH ,Am.Keb 05/01/2015 05/01/2015 155.400 RJTl B i l l ing Sis tem 5/1/2015 laboratorium

RS BETHAMEDIKA 1010R00401150000054 1800827921 IMA MULOANIYAH ,Am.Keb 04/01/2015 06/01/2015 3.537.700 RITl Billing Sistem: 4/1/2015 s.d 6/1/2015

2 Bakt i Medicare 0118R00510140000688 1144499286 ASEP KURNIA 15/10/2014 15/10/2014 155.400 RJTl B i l l in g S i s te m : 1 5 /1 0 /2 0 14 P o l i M a t a

R5UO SEKARWANGI 1010R00210140006636 1144499286 ASEP KURNIA 12/10/2014 20/10/2014 6.306.900 RITl Berkas belum di terima

3 Bakt i Medicare 0118R00506140000654 1258438781 PAROI 30/06/2014 30/06/2014 132.711 RJTl B i l l in g S i s te m : 3 0 /6 /2 0 14 P o l i Intern is laboratorium

R5UO R. 5AM5UOIN l009Rool06140012962 1258438781 PAROI 28/06/2014 07/07/2014 6.428.510 RITl Berkas belum di terima

4 Bakt i Medicare 0118R00502150002692 1137861178 5UPAROI 06/02/2015 06/02/2015 132.700 RJTl B i l l ing Sis tem 6/2/2015 Pal i Internis laboratorium

R5UO SEKARWANGI 1010R00202150001497 1137861178 SUPARDI 05/02/2015 07/02/2015 1.983.200 RITl Berkas belum di terima

5 Bakt i Medicare 01 18 R0 05 06 14 00 00 326 1 315 85 17 04 UJAN G RAHM AT 0 3/0 6/2 01 4 03/06/2014 235.678 RJTl Berkas belum di terima

R5UO R. SAMSUDIN loo9Rool06140001335 1315851704 UJANG RAHMAT 02/06/2014 10/06/2014 10.336.124 RITl Billing Sistem :2/6/2014 s.d 10/6/2014

7/23/2019 RS BMC(1).pdf


Lampiran 8

No nosjp nokapst nmpst tgldtgsjp tglplgsjp ByTagSJP Selisih NmJnsPel

1 0118R00505150000184 1465031002 KA5TOMIHARJO 04/05/2015 04/05/2015 132.200 132.200 RJTL

0118R00505150000117 1465031002 KASTOMIHARJO 04/05/2015 04/05/2015 2300400 RJTL

2 0118R00508140001006 1138599955 RESTUA5TRIATI 31/08/2014 31/08/2014 155.372 RJTL

0118R00508140001051 1138599955 RESTUASTRIATI 31/08/2014 31/08/2014 155.372 155.372 RJTL

287.572

rs bmc(1).pdf

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