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PhilHealth holds stakeholder consultation to resolve claims issues June 29, 2018
IN keeping with its commitment to closely work with key stakeholders in aid of policy and process improvement, the Philippine Health Insurance Corporation (PhilHealth) has recently conducted a multi-sectoral dialogue to address two major issues arising from the implementation of PhilHealth Circular No. 2018-007 which it deferred early this month.
The said circular entitled "Documentary Requirements for Claims Reimbursement and Medical Prepayment Review of Claims" prescribes the use and submission of Claim Form 4 (CF4) for all admissions starting June 1, 2018, among others.
The said form summarizes a patient's pertinent clinical information and eliminates the submission of complete clinical charts for all claims for reimbursement.
PhilHealth deferred the implementation of CF4 in response to the request of the Private Hospitals Association of the Philippines, Inc. (PHAPI) during a joint congressional hearing on May 30.
During the said stakeholder meeting, attendees from the PHAPi, Department of Health – Pharmaceutical Division (DOH-PD), Philippine Hospital Association (PHA), and the Philippine Medical Association (PMA) have acknowledged the importance of CF4 in ensuring quality of care through a review of provider compliance to PhilHealth's policies and accepted medical practice.
The stakeholders have agreed on the full use of the CF4 starting September 1, 2018, providing ample time for accredited hospitals to train their personnel accordingly as well as make the necessary adjustment in their systems.
The said consultation also served as venue for PhilHealth to clarify that it continues to abide by its policy to pay only for drugs and medicines that are in the Philippine National Formulary (PNF) which was one of the provisions of PhilHealth Circular No. 2018-007 that became a concern among providers as a result of the deferment.
The PNF is a list of essential medicines prepared by the National Formulary Committee in consultation with experts and specialists from organized professional medical societies, medical academe and the pharmaceutical industry; and is an integral component of the Philippine Medicines Policy which aims to make quality essential drugs available, accessible, efficacious, safe and affordable.
Republic Act 7875, as amended requires that only drugs and medicines that are in the PNF shall be paid for by PhilHealth, a matter that was unanimously acknowledged by all the stakeholders present.
In cases where providers will insist on the use of non-PNF listed drugs, they were advised to coordinate directly with the Department of Health for the inclusion of the drugs of their choice in the said list.
To keep tab of the progress of the agreements and to continuously collaborate on other program concerns, the group has committed itself to periodic meetings in the coming months. (END)
Reference: Corporate Affairs Group | Trunkline: 441-7444 loc. 7652 & 7653
