PhilHealth
home | contact us | sitemap | disclaimer
News
PhilHealth, Hospital and Medical Associations Agree on Major Issues July 11, 2018
THE country’s lead organizations of health care institutions and medical professionals have reached an accord with the Philippine Health Insurance Corporation (PhilHealth) to synergize efforts and ensure better implementation of the National Health Insurance Program (NHIP).
Present during the meeting held at PhilHealth’s Head Office in Pasig City last week were Acting PhilHealth President and Chief Executive Officer Dr. Roy B. Ferrer, Dr. Rustico Jimenez, President of the Private Hospitals Association of the Philippines, Inc (PHAPI), Dr. Jesus M. Jardin, Vice President for Mindanao of the Philippine Hospital Association (PHA) and Dr. Jose P. Santiago Jr., President of the Philippine Medical Association (PMA). Also present were Dr. Irene Florentiño Fariñas, Joyce Ann Ceria Pereña, and Dr. Anna Melissa Guerrero of the Department of Health’s Pharmaceutical Division.
The medical associations agreed to implement the provisions of PhilHealth Circular 2018-0007 which introduces the Claim Form 4 for claims starting September 1. The form summarizes a patient's pertinent clinical information and eliminates the submission of complete clinical charts for all claims for reimbursement. PhilHealth earlier deferred the implementation of the said policy based on the request of the PHAPI.
The parties acknowledged the advantages of using the Claim Form 4 as it will ensure quality of care through a review of provider compliance to PhilHealth's policies and accepted medical practice. They also agreed on the new implementation date, noting that it will give them enough time to train their staff in using the said form.
During the meeting, PhilHealth also emphasized among the medical practitioners that only drugs and medicines that are listed in the latest edition of the Philippine National Formulary will be paid for. The clarification was made in light of concerns raised by the providers as a result of the deferment of implementation of PC 2018-0007.
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.
PhilHealth also advised providers that should they continue to prescribe and use drugs and medicines that are not listed in the PNF, they should directly coordinate with the DOH so that these medicines can be included in the PNF.
Addressing news reports that some hospitals are on the brink of closing down due to delayed reimbursements, PhilHealth bared its efforts to ensure speedy, yet accurate evaluation and processing of claims for medical reimbursement. These included the hiring of 206 encoders who were deployed to Regional Offices to help in the encoding of entries in claim forms. Some Regional Offices are also working overtime to cope with the influx of claim documents to review and process.
It has also continued to advocate among its accredited providers the use of electronic claims (eClaims) to enable them to submit the claim documents online. Various options to implement the eClaims were also provided to ensure immediate compliance.
The state-run health insurer is also pro-actively informing providers about the status of their claims through their official e-mail accounts. The email messages contain information on the status of claims paid, claims that are still for payment, claims that are pending, denied and returned to the providers. The initiative will facilitate the reconciliation of PhilHealth’s records with those of its providers.
Ferrer appealed to PhilHealth’s partner-providers to honor the agreements reached and to get in touch with him or his team for any other concerns, instead of using national media. (END)
Reference: Corporate Affairs Group | Trunkline: 441-7444 loc. 7652 & 7653
