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PhilHealth, Hospital and Medical Associations Agree on Major Issues July 11, 2018

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

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PhilHealth, Hospital and Medical Associations Agree on Major Issues