At least 99 participants from 104 hospitals under PhilHealth Regional Office XII attended the Project Reach Out Forum held recently at Villa Amor Hotel in the City of Koronadal, South Cotabato.

Project Reach Out Forum is held quarterly to provide updates for accredited health care providers in the Region.

“This is the second meeting we have for the year and we are looking forward to another fruitful and productive day with you,” Project Reach Out Team Leader, Dr. Antoniette M. Ladio said.

According to PhilHealth XII Field Operations Division Chief, Engr. Eugenio Donatos, the forum is on the credit side because it deals with policies in terms of paying hospitals unlike the marketing forum activities that deal with the debit side.

“I do understand that each one of you as our partner in implementing the National Health Insurance Program has your unique number and your own unique story. Our members also have their unique numbers and they too, have their stories. Ours is a promise to make those stories fulfilling and promising for them. I hope you too, would share the same stories by delivering our promises that are fulfilling for them,” Donatos said.

During the open forum, Benefits Administration Section Head Dr. Henry F. Manzares stressed the need to write only the correct information in the Statement of Account, Form 2 and in other required documents for claims processing. “We are paying for the services that you are giving to our members. Please be consistent with figures in all your attachments. Write only what is true. Kindly include contact numbers of the members/patients themselves. It is mandatory.”

Special Investigator II Sharon Bona from the Legal Services Office pointed this out when one of the clients asked how they should deal with patients who are lying about their identities, their dependent spouse and dependent children. She said that those who fabricate or provide false information are liable for any violation against relevant policies.

Donatos added that as partners in implementing the NHIP, hospitals also have their duties in protecting the National Health Insurance Fund by checking if the members they are admitting are legitimate or not.

Borrowed identity and fake membership were emphasized as patent forms of fraudulent activities and are considered unlawful in the benefit availment process.

On the other hand, hospitals with PhilHealth Customer Assistance, Relations and Empowerment Staff or P-CARES are mandated to provide these personnel with work stations and logistics. “These nurses have their duties and responsibilities that help our members understand their benefits and the benefit availment process. We will be deploying them per month in identified hospitals and no longer per quarter. Please accommodate them well,” PhilHealth XII CARES Supervisor Raffy B. Elizares said.

Senior Social Insurance Officer, Joy S. Lizada also reminded the participants, who are also employers, to adopt the new Electronic Premium Remittance System (EPRS) and to secure the Statement of Premium Accounts (SPA) before settling their obligations with PhilHealth.

In terms of claims disbursement, Cashiering Unit Head, Ma. Luna Soriano stressed that PhilHealth strictly imposes the “no OR, no check” policy. “Those who are sending representatives please take note that the SPA or Special Power of Attorney remains a mandatory requirement. The SPA is only valid for one year, unless revoked. Kindly renew it every year to avoid inconvenience in claiming your checks,” she said.

Other issues and concerns were answered thoroughly by the panelists. Health Care Delivery and Management Division Chief, Dr. Edson F. Pama thanked the participants for joining the Reach Out Forum. (END) (Hanah G. Naanep)