Republic of the Philippines

PHILIPPINE HEALTH INSURANCE CORPORATION

Citystate Centre Building, 709 Shaw Blvd., Pasig City
Healthline (02) 441-7444 www.philhealth.gov.ph

PhilHealth CARES Report

PhilHealth Regional Office: NCR-Central
Month: March
Issues and Concerns

Membership

Contribution

Health Care
Provider
Relations

Benefits

1. Member Data Records (MDR) and 4Ps ID still contain

multiple errors and discrepancies or not updated.
2. Case wherein a 4Ps member whos all of his children having
their own 4Ps ID or membership. (reported)
3. Invalid sponsored validity period present in the I-CARES
system.
1. Employees both from the public and private sectors often
complain about the unposted contributions in PhilHealths
system.
2. ACA receiving monthly payment from a member belonging to
the informal ecomony (UCPB-Novaliches)
3. Members still have a lot negative feedbacks/ reactions
regarding the increase in premium contributions. NonPhilHealth members verbalized that they cannot afford
paying the cost of our new premium contributions.
4. Underpayment made by members on some accredited
collecting agents due to unawareness to the new premium
contribution.
5. Some employers signed the CF1 even though the member
havent been employed in the company for at least 3 months.
1. Hospital requiring unnecessary documents in filing of
members claim. Philippines Children Medical Center
2. Hospital does not specify professional fee on the statement of
account World Citi Medical Center, Philippines Children
Medical Center
3. Hospital requiring Certificate of Contribution from the
employer even though CF1 is properly accomplished
Novaliches General Hospital
1. A lot of members are complaining of why is direct filing is not
allowed anymore since some of them cannot comply with the
requirements during confinement. .
2. Most of the members complain for the SPC ruling and lower
amount of ACR package compare to FFS.
3. Members and hospital staffs were disappointed for the delay
in the approval of pre-cataract authorization, it took more
than 7 days to approved thus delay/rescheduling of the
operation is observed.
No Balance Billing:
Hospitals that are not compliant with the NBB are as follows:

OthersS

1. East Avenue Medical Center

2. Philippines Orthopedic Center
All Case Rates:
1. Some members express dissatisfaction to the new case rate
amount. They perceive lesser benefits for new case rates
amount compared to the previous FFS payment scheme.
2. Some diagnosis were still not compensable
IHCP Portal (PBEF)
1. Some hospital have no available printer for PBEF printing.
2. Inconsistency of data between PBEF and MDR
3. Payment done in some ACAs were not reflected on PBEF thus
tagged as not eligible to claim,
4. OFW whose validity has expired was still eligible in PBEF
5. Dependent was declared in I-CARES but not on PBEF
6. PBEF is currently used only for viewing patient/members
eligibility but not as a replacement for MDR on some hospital.
7. PBEF is not providing any information if the medical case or
procedure is covered by SPC.
Point of Care:
1. Patients who are enrolled on POC were not provided with
payment slip details and certification from the Medical
Social Worker Service which causes delay and trouble during
their confinement on other hospitals.
2. POC is suspended in QMMC starting March 11, 2014.
3. Slow internet connection of the hospital cause delay on the
enrolment of HSM.
4. Some class C3 and D patients/members are enrolled only on
the date the patient is due for discharge, hence defeating its
very purpose to uphold NBB.
Internal:
1. CARES requesting for additional supply of pamphlets, flyers,
brochures and new form regarding the new PhilHealth
policies.
2. Unstable i-CARES system most of the days in the month of
February
3. CARES suggest that advisories or publications of any kind
from PhilHealth must be anticipated and be conveyed to
CARES prior to its release
4. Draft guidelines for CARES allowing them to participate in
round table discussions or meetings involving their hospital
duty and PhilHealth
5. Keep the line of communication among CARES and
supervisors open and on time
6. CARES suggest for ICD10 training.
7. Deploy two CARES for hospitals with large volume of clients.

Commonly Violated PhilHeallth Circulars

Observed Hospital Practice/s
Not compliance with the NBB Policy

Circular/s
No. 11, s-2011
No. 22, s- 2012

Prepared by:
Richard P. Sonsing
PMT-CARES

Noted by: