The Philippine Health Insurance Corporation (PhilHealth), through Advisory No. 2018-0014, directs Health Care Institutions (HCIs) contracted for Z Benefits to manually file their claims for the benefit package accorded to catastrophic illnesses. The advisory was released last February 9, 2018.
Instead of utilizing the Electronic Claims System (eClaims) for Z Benefit claims, the contracted HCIs need to submit all required documents straight to PhilHealth offices for evaluation, processing, and payment. Effective immediately, eClaims should only be used for claims on All Case Rates (ACR), outpatient benefit packages (e.g. Maternity Care Package, Dialysis, Animal Bite Treatment Package), and others that shall be defined by PhilHealth.
In addition, PhilHealth Advisory No. 2018-0020 calls on treatment facilities serving as access points for Outpatient Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome Treatment Package (OHAT) to file their reimbursements manually. The advisory instructs HIV treatment and satellite hubs to follow the current procedures of filing claims for the OHAT Benefit Package.
These directives shall remain in effect until further notice.
Further inquiries relating to these new developments may be referred to PhilHealth’s 24/7 Corporate Action Center Hotline (02) 441-7442. Clarifications, comments, and suggestions may also be sent via electronic mail to actioncenter@philhealth.gov.ph, or through PhilHealth’s official social media sites, Twitter (@teamphilhealth) and Facebook (facebook.com/PhilHealth). (END) (By JJ Rico)
(Reference: Dr. Israel Francis A. Pargas, Head Executive Assistant and Concurrent OIC-Vice President for Corporate Affairs Group, Cel No. 0917-8089399)
