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NONAMA PASIEN NO INVOICETGL PENAGIHANNO SKPTGL MASUKTGL KELUARRMDiagnosaTindakanKELASRUANG PERAWATANLama RawatR INAPKAMAR BERSALINKAMAR OPERASIPENUNJANG MEDISBEKAL KESEHATANTNDKJASA TENAGA KESEHATANBED SIDE MONITORBANK DARAHGAS MEDISPMIHDADMMRI/ PEMERIKSAAN LUAR AMBULANCETIND. ICUGIZIPenunjang LainnyaTOTALKLAIMSELISIH (DIBAYAR PASIEN/COB)NAMA DOKTER
JASA DOKTER
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LABEKGROFISIO TXOBATAMHPUGD/POLIDOKTERJASA PERAWATASKEPKEMOTERAPITIND. ICUdr.1dr. 2dr.3dr.4dr.5dr. 6dr. 7dr. 8dr.1dr.2dr.3dr.4dr.5dr. 6dr. Operatordr. Anestesidr. UGD Tertera dikwitansiKeterangan
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JANUARI 2024
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RS BHAYANGKARA
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1WidaningsihB/57/I/202418 January 2024SP/81/XII/KES/2023/Rumkit Bhy29 December 202329 December 2023070799MPVIPCendrawasih1,000,000 7,392,000 120,000 697,000 100,000 300,000 9,609,000 9,609,000 dr. Wahyu, Sp.S
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0
10
9,609,000 9,609,000
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0
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RS BHAYANGKARA
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1Satria Bagus MaulanaB/125-18/12/06/RSPAU20 Februari 202406 February 202408 February 2024274107-IIIsolasi Ged. D722,000 75,000 225,350 345,500 312,500 140,000 20,000 1,840,350 1,840,350 dr EKO ARIBOWO Sp. pd
dr. M. PATARA AULIA PUTRA
dr. KEVIN DARMAWAN
dr. RACHMAT ARYADI BIMANJAYA
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2Layung RetnoB/125-18/12/06/RSPAU20 February 202406 February 202408 February 2024274098IIIsolasi Ged. D722,000 75,000 251,550 365,000 312,500 140,000 20,000 1,886,050 1,886,050 dr EKO ARIBOWO Sp. pd
dr. M. PATARA AULIA PUTRA
dr. SYAHWINA INAYASARI
dr. RACHMAT ARYADI BIMANJAYA
dr. PRAMUDITO CAHYO JANUARYADI
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3Ero ArsyadB/125-18/12/06/RSPAU20 February 202406 February 202408 February 2024274102IIIsolasi Ged. D722,000 75,000 226,200 345,500 312,500 140,000 20,000 1,841,200 1,841,200  dr EKO ARIBOWO Sp. pd
dr. M. PATARA AULIA PUTRA
dr. SYAHWINA INAYASARI
dr. RACHMAT ARYADI BIMANJAYA
dr. PRAMUDITO CAHYO JANUARYADI
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4Rofi UdinB/125-18/12/06/RSPAU20 February 202406 February 202408 February 2024274099IIIsolasi Ged. D722,000 75,000 224,600 395,000 312,500 140,000 20,000 1,889,100 1,889,100  dr EKO ARIBOWO Sp. pd
dr. M. PATARA AULIA PUTRA
dr. SYAHWINA INAYASARI
dr. RACHMAT ARYADI BIMANJAYA
dr. PRAMUDITO CAHYO JANUARYADI
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5Adhyasta Prayoga AB/125-18/12/06/RSPAU20 February 202406 February 202408 February 2024274105IIIsolasi Ged. D722,000 75,000 227,650 345,500 312,500 140,000 20,000 1,842,650 1,842,650  dr EKO ARIBOWO Sp. pd
dr. M. PATARA AULIA PUTRA
dr. SYAHWINA INAYASARI
dr. RACHMAT ARYADI BIMANJAYA
dr. PRAMUDITO CAHYO JANUARYADI
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6Gaur Chandra SusilaB/125-18/12/06/RSPAU20 February 202406 February 202408 February 2024274104IIIsolasi Ged. D722,000 75,000 231,700 345,500 312,500 140,000 20,000 1,846,700 1,846,700  dr EKO ARIBOWO Sp. pd
dr. M. PATARA AULIA PUTRA
dr. SYAHWINA INAYASARI
dr. RACHMAT ARYADI BIMANJAYA
dr. PRAMUDITO CAHYO JANUARYADI
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7Burhan NurB/125-18/12/06/RSPAU20 February 202406 February 202408 February 2024274103IIIsolasi Ged. D722,000 75,000 235,400 345,500 312,500 140,000 20,000 1,850,400 1,850,400  dr EKO ARIBOWO Sp. pd
dr. M. PATARA AULIA PUTRA
dr. SYAHWINA INAYASARI
dr. RACHMAT ARYADI BIMANJAYA
dr. PRAMUDITO CAHYO JANUARYADI
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8Abinawa Gading SB/125-18/12/06/RSPAU20 February 202406 February 202408 February 2024274106IIIsolasi Ged. D722,000 75,000 212,650 345,500 312,500 140,000 20,000 1,827,650 1,827,650  dr EKO ARIBOWO Sp. pd
dr. M. PATARA AULIA PUTRA
dr. SYAHWINA INAYASARI
dr. RACHMAT ARYADI BIMANJAYA
dr. PRAMUDITO CAHYO JANUARYADI
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9Syahril Revaryanto GB/125-18/12/06/RSPAU20 February 202406 February 202408 February 2024245085IIIsolasi Ged. D722,000 75,000 237,250 345,500 312,500 140,000 10,000 1,842,250 1,842,250  dr EKO ARIBOWO Sp. pd
dr. M. PATARA AULIA PUTRA
dr. SYAHWINA INAYASARI
dr. RACHMAT ARYADI BIMANJAYA
dr. PRAMUDITO CAHYO JANUARYADI
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10Kinanthi Kembang AB/125-18/12/06/RSPAU20 February 202406 February 202408 February 2024274109IIIsolasi Ged. D722,000 75,000 246,900 345,500 312,500 140,000 20,000 1,861,900 1,861,900  dr EKO ARIBOWO Sp. pd
dr. M. PATARA AULIA PUTRA
dr. SYAHWINA INAYASARI
dr. RACHMAT ARYADI BIMANJAYA
dr. PRAMUDITO CAHYO JANUARYADI
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11Rinto HatmokoB/125-18/12/06/RSPAU20 February 202406 February 202408 February 2024274111IIIsolasi Ged. D722,000 75,000 187,500 345,500 312,500 140,000 20,000 1,802,500 1,802,500  dr EKO ARIBOWO Sp. pd
dr. M. PATARA AULIA PUTRA
dr. SYAHWINA INAYASARI
dr. RACHMAT ARYADI BIMANJAYA
dr. PRAMUDITO CAHYO JANUARYADI
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12Budi SetiawanB/125-18/12/06/RSPAU20 February 202406 February 202408 February 2024274110IIIsolasi Ged. D722,000 75,000 201,250 345,500 275,000 140,000 20,000 1,778,750 1,778,750  dr EKO ARIBOWO Sp. pd
dr. M. PATARA AULIA PUTRA
dr. SYAHWINA INAYASARI
dr. RACHMAT ARYADI BIMANJAYA
dr. PRAMUDITO CAHYO JANUARYADI
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13Kharistyo Bima AB/125-18/12/06/RSPAU20 February 202406 February 202408 February 2024002126IIIsolasi Ged. D722,000 75,000 198,700 345,500 312,500 140,000 10,000 1,803,700 1,803,700  dr EKO ARIBOWO Sp. pd
dr. M. PATARA AULIA PUTRA
dr. SYAHWINA INAYASARI
dr. RACHMAT ARYADI BIMANJAYA
dr. PRAMUDITO CAHYO JANUARYADI
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14M Sandi Permana B/125-18/12/06/RSPAU20 February 202406 February 202408 February 2024274100IIIsolasi Ged. D722,000 75,000 205,700 345,500 312,500 140,000 20,000 1,820,700 1,820,700  dr EKO ARIBOWO Sp. pd
dr. M. PATARA AULIA PUTRA
dr. SYAHWINA INAYASARI
dr. RACHMAT ARYADI BIMANJAYA
dr. PRAMUDITO CAHYO JANUARYADI
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15Rangga PutraB/125-18/12/06/RSPAU20 February 202406 February 202408 February 2024274097IIIsolasi Ged. D722,000 75,000 196,100 345,500 312,500 140,000 20,000 1,811,100 1,811,100  dr EKO ARIBOWO Sp. pd
dr. M. PATARA AULIA PUTRA
dr. SYAHWINA INAYASARI
dr. RACHMAT ARYADI BIMANJAYA
dr. PRAMUDITO CAHYO JANUARYADI
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16M. Tegar Nur IrfanB/125-18/12/06/RSPAU20 February 202406 February 202408 February 2024242028IIIsolasi Ged. D722,000 75,000 216,800 365,500 312,500 140,000 10,000 1,841,800 1,841,800  dr EKO ARIBOWO Sp. pd
dr. M. PATARA AULIA PUTRA
dr. SYAHWINA INAYASARI
dr. RACHMAT ARYADI BIMANJAYA
dr. PRAMUDITO CAHYO JANUARYADI
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17Fahmi Dwi Nur RahmatB/125-18/12/06/RSPAU20 February 202406 February 202408 February 2024274108IIIsolasi Ged. D722,000 75,000 189,100 345,500 312,500 140,000 20,000 1,804,100 1,804,100  dr EKO ARIBOWO Sp. pd
dr. M. PATARA AULIA PUTRA
dr. SYAHWINA INAYASARI
dr. RACHMAT ARYADI BIMANJAYA
dr. PRAMUDITO CAHYO JANUARYADI
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18Yusuf Indra B/125-18/12/06/RSPAU20 February 202406 February 202407 February 2024274101IIIsolasi Ged. D722,000 75,000 248,750 365,500 312,500 140,000 20,000 1,883,750 1,883,750  dr EKO ARIBOWO Sp. pd
dr. M. PATARA AULIA PUTRA
dr. SYAHWINA INAYASARI
dr. RACHMAT ARYADI BIMANJAYA
dr. PRAMUDITO CAHYO JANUARYADI
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19Irawan Setya WusanaB/125-18/12/06/RSPAU20 February 202406 February 202407 February 2024224626IIIsolasi Ged. D361,000 75,000 786,150 405,500 295,000 100,000 10,000 2,032,650 2,032,650  dr EKO ARIBOWO Sp. pd
dr. M. PATARA AULIA PUTRA
dr. SYAHWINA INAYASARI
dr. RACHMAT ARYADI BIMANJAYA
dr. PRAMUDITO CAHYO JANUARYADI
33
20Muhammad MirzaB/125-18/12/06/RSPAU20 February 202406 February 202407 February 2024274167IIIsolasi Ged. D361,000 75,000 130,250 375,500 230,000 100,000 20,000 1,291,750 1,291,750  dr EKO ARIBOWO Sp. pd
dr. M. PATARA AULIA PUTRA
dr. SYAHWINA INAYASARI
dr. RACHMAT ARYADI BIMANJAYA
dr. PRAMUDITO CAHYO JANUARYADI
34
21Irfan Zaky RistiyantoB/125-18/12/06/RSPAU20 February 202406 February 202407 February 2024274171IIIsolasi Ged. D361,000 75,000 258,250 375,500 230,000 100,000 20,000 1,419,750 1,419,750  dr EKO ARIBOWO Sp. pd
dr. M. PATARA AULIA PUTRA
dr. SYAHWINA INAYASARI
dr. RACHMAT ARYADI BIMANJAYA
dr. PRAMUDITO CAHYO JANUARYADI
35
22Imelda Nur IkaB/125-18/12/06/RSPAU20 February 202406 February 202407 February 2024120247IIIsolasi Ged. D361,000 75,000 170,300 375,500 295,000 100,000 10,000 1,386,800 1,386,800  dr EKO ARIBOWO Sp. pd
dr. M. PATARA AULIA PUTRA
dr. SYAHWINA INAYASARI
dr. RACHMAT ARYADI BIMANJAYA
dr. PRAMUDITO CAHYO JANUARYADI
36
23M. Dhafin Fata NugrahaB/125-18/12/06/RSPAU20 February 202406 February 202407 February 2024274170IIIsolasi Ged. D361,000 75,000 130,450 375,500 230,000 100,000 20,000 1,291,950 1,291,950  dr EKO ARIBOWO Sp. pd
dr. M. PATARA AULIA PUTRA
dr. SYAHWINA INAYASARI
dr. RACHMAT ARYADI BIMANJAYA
dr. PRAMUDITO CAHYO JANUARYADI
37
24M. Faiz SyuhadaB/125-18/12/06/RSPAU20 February 202406 February 202407 February 2024274172IIIsolasi Ged. D361,000 75,000 899,600 435,500 230,000 100,000 20,000 2,121,100 2,121,100  dr EKO ARIBOWO Sp. pd
dr. M. PATARA AULIA PUTRA
dr. SYAHWINA INAYASARI
dr. RACHMAT ARYADI BIMANJAYA
dr. PRAMUDITO CAHYO JANUARYADI
38
25Ferdio SaputraB/125-18/12/06/RSPAU20 February 202406 February 202407 February 2024274169IIIsolasi Ged. D361,000 75,000 133,150 375,500 230,000 100,000 20,000 1,294,650 1,294,650  dr EKO ARIBOWO Sp. pd
dr. M. PATARA AULIA PUTRA
dr. SYAHWINA INAYASARI
dr. RACHMAT ARYADI BIMANJAYA
dr. PRAMUDITO CAHYO JANUARYADI
39
26M. Rafi KurniawanB/125-18/12/06/RSPAU20 February 202406 February 202407 February 2024274168IIIsolasi Ged. D361,000 75,000 203,300 375,500 230,000 100,000 20,000 1,364,800 1,364,800  dr EKO ARIBOWO Sp. pd
dr. M. PATARA AULIA PUTRA
dr. SYAHWINA INAYASARI
dr. RACHMAT ARYADI BIMANJAYA
dr. PRAMUDITO CAHYO JANUARYADI
40
27Okhi RahdityaB/125-18/12/06/RSPAU20 February 202406 February 202407 February 2024247613IIIsolasi Ged. D361,000 75,000 91,400 315,500 192,500 100,000 10,000 1,145,400 1,145,400  dr EKO ARIBOWO Sp. pd
dr. M. PATARA AULIA PUTRA
dr. SYAHWINA INAYASARI
dr. RACHMAT ARYADI BIMANJAYA
dr. PRAMUDITO CAHYO JANUARYADI
41
28Tegar Bayu CB/125-18/12/06/RSPAU20 February 202406 February 202407 February 2024232590IIIsolasi Ged. D361,000 75,000 82,250 315,500 192,500 100,000 10,000 1,136,250 1,136,250  dr EKO ARIBOWO Sp. pd
dr. M. PATARA AULIA PUTRA
dr. SYAHWINA INAYASARI
dr. RACHMAT ARYADI BIMANJAYA
dr. PRAMUDITO CAHYO JANUARYADI
42
29Ahmad Subkhi N.SB/125-18/12/06/RSPAU20 February 202406 February 202407 February 2024256358IIIsolasi Ged. D361,000 75,000 71,250 315,500 192,500 100,000 10,000 1,125,250 1,125,250  dr EKO ARIBOWO Sp. pd
dr. M. PATARA AULIA PUTRA
dr. SYAHWINA INAYASARI
dr. RACHMAT ARYADI BIMANJAYA
dr. PRAMUDITO CAHYO JANUARYADI
43
30Bryan Putra EB/125-18/12/06/RSPAU20 February 202406 February 202407 February 2024208550IIIsolasi Ged. D361,000 75,000 130,000 375,500 192,500 100,000 10,000 1,244,000 1,244,000  dr EKO ARIBOWO Sp. pd
dr. M. PATARA AULIA PUTRA
dr. SYAHWINA INAYASARI
dr. RACHMAT ARYADI BIMANJAYA
dr. PRAMUDITO CAHYO JANUARYADI
44
17,328,000 2,250,000 7,049,500 10,744,000 8,327,500 3,720,000 510,000
45
0
46
PT. KIDS FUN0
47
1Besta Anissya KPR.HD.159/GM/X/202220 February 202405 February 202408 February 2024IIIKutilang900,000 2,464,000 744,000 260,000 2,577,800 648,500 212,500 670,000 20,000 8,496,800
dr. RADEN SUHANA Sp.OT (K)
dr JOKO SAPTONO SpAn.FIP
dr. Caecilia Setianingsih , Sp. Rad, M.Sc
dr. RANTY FEMILYA UTAMI
48
58,425,800
49
0
50
51
MARET 2024
52
NIHIL
53
54
55
APRIL 2024
56
BNI-LIFE
57
1Syafara Arsnawa AfafB/268-18/12/06/RSPAU30 April 202406 March 202410 March 2024275602VIPCendrawasih4,000,000 105,000 814,050 420,000 995,000 450,000 6,784,050 dr. CITRA TARANITA, Sp. A
dr. ANJELIA AIRINE MAINDOKA
58
2Sandhy HanjarnursiswatiB/276-18/12/06/RSPAU30 April 202430 April 202403 May 2024277927VIPCendrawasih3,000,000 1,059,000 120,000 491,000 365,000 745,000 10,000 5,790,000 5,640,000 150,000 dr. EKO ARIWIBOWO, Sp.PDdr. RANTY FEMILYAdr. KHANIF MUFLIHATUN
59
0
60
CHUBB LIFE0
61
1Ade SetiawanB/269-18/12/06/RSPAU30 April 202410 April 202411 April 2024277248VIPCendrawasih1,000,000 437,000 710,000 730,850 145,000 165,000 10,000 3,197,850 dr. NUR BUDIONO, Sp.Udr. KEVIN DARMAWAN
dr. DWI ARIE CHANDRA SUKISWO, Sp.Rad
dr. CAECILIA SETIANINGSIH, Sp.Rad
62
0
63
MAPACTV0
64
1Nur WidayatiB/272-18/12/06/RSPAU30 April 202405 March 202409 March 2024275380IIIMurai1,200,000 437,000 900,000 916,800 635,500 380,000 440,000 10,000 4,919,300 dr. TIS, Sp.S
dr. KHANIF MUFLIHATUN
dr. M. PATARA AULIA
dr. ASRI AYUNING KUSUMA
dr. RINANDA YUNI LUBIS
dr. ANIKI PUSPITA
dr. CAECILIA SETIANINGSIH, Sp.Rad
65
0
66
BRI LIFE0
67
1Dewi Fatimah R.PB/275-18/12/06/RSPAU30 April 202425 March 202428 March 2024084082VIPCendrawasih3,000,000 437,000 120,000 1,029,740 612,500 740,000 10,000 5,949,240 4,299,250 1,650,000
dr. RADEN TRIYONO EDHI Sp.PD
dr. WINDA PURNAMA,Sp.KJ
dr. CAECILIA SETIANINGSIH, Sp.Rad
68
26,640,440
69
0
70
0
71
0
72
JUNI 20240
73
MEDIKA PLAZA
74
1Dyah Setyowati B02 June 202407 June 2024279970VIPCendrawasih4,200,000 562,000 120,000 1,468,100 657,500 1,235,000 10,000 8,252,600 8,252,600 0
dr. Gibran Ilham Setiawan, Sp.PD
dr. Dwi Arie Chandra, Sp.Rad
dr. Aniki Puspita
dr. Patara Aulia Putra
75
0
76
AGUSTUS 2024
77
FWD - ADMEDIKA0
78
1Astuti Endah NursantiB/543-18/12/06/RSPAU29 Agustus 202419 August 202421 August 2024284194IMurai1,200,000 60,000 816,250 237,500 595,000 2,908,750
dr. Mochamad Azhari, Sp.P(K), FISR
dr. Zuhud Nur Wibisonodr. Pramudito Cahyo J
79
80
81
BNI Life-Admedika
82
1Ahmad FadhilB/565-18/12/06/RSPAU30 August 202411 August 202415 August 2024274185VIPCendrawasih3,200,000 12,995,200 674,000 540,000 3,951,400 395,500 415,000 1,085,000 10,000 23,266,100
83
84
85
September 2024
86
BRI LIFE0
87
1Dewi Fatimah Ribut. PB/757-18/12/06/RSPAU15 Oktober 202421/09/202424/09/2024084082Cendrawasih3,000,000 275,250 1,797,500 10,000 5,082,750 3.282.7501,800,000 dr. Eko Ariwibowodr. Rondiahdr. Asri Ayuning Kusuma
dr. Bambang Setyo Gunadi, Sp.Rad
88
89
90
91
November 2024
92
BRI LIFE
93
1Tjuk SugiyonoB/819-18/12/06/RSPAU02 October 20241,000,000 4,928,000 5,907,800 225,000 400,000 10,000 12,470,800 12,470,800 dr. Wahyu Sp.S
94
95
96
MEDIKA PLAZA
97
1Fatih Razin ZaidanB/887-18/12/06/RSPAU2/10/20243,000,000 804,000 2,540,000 1,136,600 623,500 337,500 780,000 20,000 9,241,600 9,241,600
dr. Gideon Ardhya Trinovianto, Sp.B
dr. Caecilia Setianingsih, Sp.Rad
dr. Aulia Budi Agustin
98
0
99
0
100
December 20240
101
RS BHAYANGKARA0