includes claims received until August 9
August 27, 2021 – The Philippine Health Insurance Corporation (PhilHealth) announced the second implementation of the Debit-Credit Payment Mechanism (DCPM) that covers received in-process claims from April 8 to August 9, 2021.
First implemented for claims received from March 8, 2020 to April 7, 2021, the second wave of the DCPM still exclude claims that were returned to hospitals for compliance, denied, and under investigation for payment.
In addition, claims directly filed by the member, claims with invalid illness codes, and initially identified in-process claims included in the first implementation of DCPM that were returned-to-hospital and has been received by PhilHealth within the inclusive period of the second implementation of DCPM shall likewise be excluded from the computation of applicable in-process claims.
The DCPM can be availed of by health care facilities (HCFs), including previous recipients from the initial implementation of the payment mechanism that meet the following criteria:
· Must be in high and critical areas identified by the Inter-Agency Task Force or National Task Force Against COVID-19 (IATF/NTF)
· Must have no Interim Reimbursement Mechanism fund balance on record
· With claims for PhilHealth COVID-19 packages
· Was not serving the penalty of suspension during the applicable period
Eligible HCFs should submit a Letter of Intent and Undertaking to the concerned PhilHealth office or branch. Once their application is approved, PhilHealth shall facilitate settlement of 60% of the HCF’s “good” in-process claims, subject to 2% expanded withholding tax for private HCFs.
The 40% balance shall be fulfilled following full compliance to existing claims processing requirements and full reconciliation of the initial 60% payment. This is also subject to 2% expanded withholding tax.
To allow immediate compensation of services delivered by its health partners, PhilHealth, subject to the approval of its Board of Directors, may modify the inclusive dates of DCPM claims. Succeeding amendments shall be announced through a separate issuance.
For more information on this development, please send a text message to 09216300009 and receive a callback from PhilHealth’s Action Center. Suggestions, comments, and feedback may also be sent to actioncenter@philhealth.gov.ph. ###
PhilHealth now covers home isolation of mild and asymptomatic COVID-19 cases
The Philippine Health Insurance Corporation (PhilHealth) announced its coverage on home isolation of COVID-19 confirmed mild and asymptomatic patients through its Circular No. 2021-0014 published on August 19, 2021 and will take effect in 15 days from publication.
According to the Department of Health, 41% of hospital beds are occupied by mild COVID-19 cases. Further reports confirmed that 95% of hospital beds in the National Capital Region are occupied given the recent surge of COVID-19 cases. This new PhilHealth benefit can help free up hospital beds in favor of cases needing higher level of care.
The COVID-19 Home Isolation Benefit Package (CHIBP) will serve as an alternative for patients who meet certain social and clinical criteria, enabling them to receive health support in their homes.
The home isolation package can be availed of by asymptomatic patients who tested positive for COVID-19 through RT-PCR test but with no signs of the disease; and patients who exhibit mild symptoms such as fever, cough, and sore throat, among others. However, PhilHealth clarified that mild cases do not exhibit symptoms of pneumonia and hypoxia – or low blood oxygen levels – as these are only manifested in more severe cases.
The state health insurer also clarified that only those who passed both the clinical and social criteria shall be entitled to the benefit, and they can choose their preferred CHIBP provider from a list posted on PhilHealth’s website. The benefit is available only in surge areas as declared by the Inter-Agency Task Force for the Management of Emerging Infectious Diseases. PhilHealth invites all facilities in these areas to enlist as CHIBP providers at no additional accreditation fee.
Services under the package include home consultations for a minimum of 10 days, daily monitoring of patients that may be done through teleconsultation, and provision of a home isolation kit. The package, which offers coverage of P5,917 per claim, also includes other services such as patient education and referral to a higher-level facility, if needed.
CHIBP providers may refer patients to higher-level facilities should they experience deterioration during home isolation. If the patient expires during home isolation, the facility can still file a claim.
PhilHealth also reminded that filing of CHIBP claims must be done electronically by the facility and shall be processed within 60 calendar days from receipt.
For more information on this new benefit, members and facilities may direct their inquiries to PhilHealth Regional, Branch or Local Health Insurance Offices. Queries may also be sent via e-mail at actioncenter@philhealth.gov.ph, or thru its Callback Channel 09216300009 where one receives a return call from the PhilHealth Action Center. ###
PhilHealth suspends TSPC indefinitely
August 29, 2021 – The Philippine Health Insurance Corporation (PhilHealth) announced today the suspension of its PhilHealth Circular No. 2021-0013 on the Temporary Suspension of Payment of Claims to address issues arising from the said issuance.
However, PhilHealth assures the public that its anti-fraud program is still in full force to protect the National Health Insurance Fund.
For more information on this development, please send a text message to 09216300009 and receive a callback from PhilHealth’s Action Center. Suggestions, comments, and feedback may also be sent to actioncenter@philhealth.gov.ph. ###