News
Member Data Record Now Required for PhilHealth Claims - June 2007
MEMBERS of the Philippine Health Insurance Corporation (PhilHealth)
must now attach a copy of their member data records to documents pertaining
to their hospitalization claims, including that of their legal dependents.
Through Circular 07, series of 2007 (as amended), Lorna O. Fajardo,
Acting PhilHealth President and CEO called on the 64 million-strong
PhilHealth membership to help strengthen data verification at the
hospital level by ascertaining the identity and eligibility of their
legal dependents who are availing themselves of benefits under their
membership. The new policy applies to claims with admission
dates starting September 1 this year.
"We are now making the Member Data Record (MDR) a primary
document in claim applications to also reduce the incidence of claims
being returned to the hospital as well as claims that are doubtful
in nature," Fajardo said. As such, she added, "all
PhilHealth members, including those from the employed sector, are
now required to submit and attach a clear copy of the MDR to PhilHealth
Claim Form 1" when filing for benefits for a dependent’s
confinement.
The MDR is a document that lists the primary information on a PhilHealth
member. It also contains the names of the member’s qualified
legal dependents and is used for reference purposes during benefits
availment.
If a member is not able to present an updated MDR, secondary supporting
documents such as birth certificate, marriage contract and other documents
may be accepted to ensure benefit claim availment.
"Members who do not yet have a copy of their MDRs may secure
copies, free-of-charge, from any of our 17 Regional and 84 Service
Offices nationwide," Fajardo said. In case of discrepancy
between what the MDR lists and the member’s or dependents’
true information, members are encouraged to fill out Form M2 or the
data amendment form and to attach to it all the supporting documents
to establish dependency. "We hope to ensure that only those
who are qualified to avail of the medical care benefits are granted
the hospitalization package in any of our accredited partner-hospitals
nationwide," Fajardo stressed.