THE Philippine Health Insurance Corporation (PhilHealth) recently conducted a four-day orientation and dialogue with representatives from Primary Care Benefit 1 (PCB1) Providers and Health Care Institutions (HCIs) in the National Capital Region (NCR) including Rizal Province for the full implementation of Electronic Medical Records (EMRs) for PCB1 Providers and Electronic Claims System (E-claims) for the HCIs.
Representatives from PCB 1 Providers and HCIs from Regions IV-A, IV-B and V were similarly oriented on the two new approaches to claims filing and submission. The activity was held at the Crowne Plaza Manila Galleria in Pasig City.
The orientation was divided into four sessions: the first two days were intended for hospitals and PCB 1 provider representatives of NCR and the last two sessions were allotted for Regions IV-A, IV-B and V.
In his welcome remarks, Dennis S. Mas, PhilHealth Regional Vice President for NCR emphasized that "adopting the EMR system will help make your profiling, recording and reporting processes easier and efficient" and added that “this orientation is important because compliance to system requirement is now mandatory. Otherwise, claims filed will not be paid.”
The EMR is an electronic record of health-related data or information of an individual done in a primary care setting. Its functions include patient registration and recording, medical record management, doctor’s order and management, laboratory/diagnostics request and results entry, e-prescription, drug dispensing, schedule of next visits/appointments, notification through short messaging system (SMS) and RxBox integration. This system will be provided for by accredited EMR Providers such as I-ClinicSys (Integrated Clinic Information System) of the Department of Health (DOH), CHITS (Community Health Information Tracking System), ShineOS+ (Secured Health Information Network and Exchange), WAH (Wireless Access for Health), Segworks and eHatid.
On the other hand, the E-claims aims to provide HCIs with the online capability to verify a patient’s eligibility for health insurance, submit claims electronically, and track the status of claim reimbursement. The PhilHealth has accredited seven (7) Health Information Technology Providers (HITPs), namely, TOPAZ Philippines, Eurolink, Medilink, BIZBOX Inc., TTSI (Total Transcription Solutions Inc.), Segworks and the DOH. They provide HCIs with the means to connect to PhilHealth and transact business electronically.
Individual presentations of representatives from EMR providers and HITPs were also done.
In one of the sessions, Dr. Jocelyn Maala, PCB Team Head shared the DOH’s memorandum requiring all Rural Health Units (RHUs)/ Rural Health Centers to do their profiling. “You have to start the profiling of your patients now because this is a mandate coming from the DOH and we have to do the profiling for all,” she stressed.
Issues raised by the PCB providers on the EMR implementation include the processing of the memorandum of agreement, implication of the issued no-functional EMRs on the accreditation of their facilities, and for data to be automatically recorded in the system without cost. There was also a suggestion for the system to have an offline feature.
Questions raised by the HCIs on E-claims include PhilHealth’s readiness to implement the e-claims system, the final implementation date, and the parties involved in the memorandum of understanding. There was also a request to extend the implementation date.
Jay Bernolia, the Officer-in-charge Senior Manager of PhilHealth’s Information and Technology Management Department (ITMD) clarified that “at the moment, only case rates can be submitted and processed by the HITPs.” He added that “claims for Z Benefits for selected hospitals, sensitive illnesses like HIV and other special benefits, direct filing from abroad and fee for service are not yet covered by the e-claims system.”
As regards the transition period, Bernolia said that, “the transition period is now until April 31st, but we can no longer move the implementation date.”
For PCB1 providers, the full implementation of the EMR system will be on April 1, 2017 while for the HCIs, the full implementation of the E-claims system will be on May 1, 2017.
All PCB 1 Providers and HCIs nationwide are expected to comply with the policy, and engage with their chosen EMRs and HITPs by date of implementation.
The initial orientation was conducted in Iloilo City in December 2016 for the PCB1 Providers and HCIs of Area 3 covering Regions 6, 7 and 8. The last batch of the orientation was recently conducted in Pasig City for representatives from Area 1 covering Regions CAR, 1, 2 and 3. (END) (Faudia H. Subillaga)