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Timestamp

FIRST NAME

LAST NAME

Region

Email Address

Reporting Month

CARES Status

EXAMPLES: 8/115/2014 ; 8/1,


3,5,6,10/2014

From

To

Name of Facility

Hospital Category

No. of NonPhilHealth
No. of PhilHealth
member/dependent member/dependent

Hospital Level

No. of
member/dependent
who are able to
avail of the
benefits

Hospital's Best
Practices

Formal Economy

Informal Economy Lifetime Members

Indigents (NHTSPR)

Sponsored
Member

# of Client's served
during ward
classes, mother's
class, opd
lectures,etc.

Non-Member

Membership

Contribution

ACAs

Healthcare
Provider Relations

Benefits
No Balance Billing
1. At Our lady of
lourdes Hospital, a
client under the
membership of
Self Employed
asked for
assistance about
her final statement
of account. I
noticed that the
hospital is not
maximizing the
philhealth package
or benefits, the
hospital is forcing
theMember to pay
the laboratories
even their actual
total hospital
charges are below
the case rate
amount.

All Case Rate

Point of Care

NHTS-PR/4PS

HCI Portal and


PBEF, i-CARES
and MCIS

Internal

Email1 Template
Status[1]

Actions Taken:
I asked the
hospital staffs in
charged at
PhilHealth Billing
about the clients
complaint and the
under deduction
they had made.
According to them,
they were informed
that the
procedures who
were not related to
the case excluded
to the bill. I
explained to the
hospital staff the
principle behind
Case-based
payment scheme. I
alsotold them that
the Corporation
will pay the
hospital bill
(package) on the
exact allotted
value of the case. I
also educated the
hospital staffs
about the Case
Rate Payment
Scheme and how
is it different to Fee
for Service last
year. At the end
the hospital
decided to deduct
the correct amount
and they were not
obliging the
member to pay the
laboratories.
I reported this
issue to our task
leader and LHIO.
2. The hospital is
requiring
unnecessary
documents in filing
of claims for
automatic
deductions like
certificate of
premium
contributions from
the employer even
the member
already has a
signed CF1 (Part
IV) from the
employer.
Actions Taken:
-CARES informed
the hospital
regarding the
documents that
are needed in filing
claims for
automatic
deductions. The
hospital justifies
that it is their policy
and for their
security and safety
purposes to
prevent return to
hospital claims.
CARES decided to
clarify or explain
the hospital policy
for every client so
that members and
dependents would
not think that
availing PhilHealth
benefits is difficult
or hard. CARES
informed the LHIO
and PRO about
this matter.
3. The common
complaint of
members/dependents
was the high rate
of professional
fees which lead to
a
misunderstanding
that professional
fees are not
included in their
philhealth
benefits/package.
Actions Taken:
I carefully
reviewed the
Statement of
Account issued by
the billing section
and noticed the
Professional Fees,
laboratories, drugs
and medicine are
overpriced I also
noticed that the
hospital deducted
the correct
philhealth
deduction, I
explained to the
member that since
the Our Lady of
Lourdes Hospital
hospital is a
private hospital
they have the right
to increase their
price of medicines,
Laboratories and
Professional Fees,
but I instructed the
member to check if
the philhealth
benefit/ package is
correct.
4. The hospital is
still obliging the
philhealth
member/dependent
to sign in the blank
Statement of
Account and Claim
Form 2 (CF2) Part
IIIB which means
the drugs and
medicine,
laboratories, room
and board,
professional fees
and others are not
itemized

AUGUSTO
6/2/2014 15:00:58 CEAZAR

PERPETUA

5 acperpetua13@gmail.com
May

Roving

5/1-17/2014

OUR LADY OF
LOURDES
HOSPITAL

Private

30

28

55

11

25

120

Actions Taken:
I informed the
Hospital Philhealth
staff that they must
not force philhealth
member/dependent
to sign in the blank
Statement of
Account. The
member has the
right to view the
detailed SOA
before discharge
to avoid
confusion/misunderstanding.
I reported this
issue to our task
leader to refer or
mention this
problem in our
anti-fraud legal
team.

1. They are not


using the
Enhanced Health
Care Institutional
Portal.
Actions Taken:
I informed the
billing staffs
regarding
Philhealth Circular
02 series of 2014
which means if
they use the
Enhanced Health
Care Institutional
Portal they can
see the members
profile. If the
member has been
verified through
this portal, they
can generate
Philhealth Benefit
Eligibility Form
(PBEF) and PBEF
shall provide
answers regarding
the eligibility of the
patient. The
generated PBEF
shall be attached
to the claims
replacing the
MDR. I also
instructed them
how useful this
Portal to the
benefits of the
hospital and
philhealth
members to save
time, energy and
money. They told
me that the
internet connection
of the hospital was
so slow thats why
they still requiring
MDR to philhealth
members.

Email1 Template
sent to
acperpetua13@gmail.com
on 06/02/14 at 3:
01:06 PM

itemized

Timestamp

FIRST NAME

AUGUSTO
6/2/2014 15:00:58 CEAZAR

LAST NAME

PERPETUA

Region

Email Address

Reporting Month

5 acperpetua13@gmail.com
May

CARES Status

Roving

EXAMPLES: 8/115/2014 ; 8/1,


3,5,6,10/2014

From

To

Name of Facility

OUR LADY OF
LOURDES
HOSPITAL

5/1-17/2014

Hospital Category

No. of NonPhilHealth
No. of PhilHealth
member/dependent member/dependent

Hospital Level

Private

No. of
member/dependent
who are able to
avail of the
benefits

Hospital's Best
Practices

Formal Economy

30

Informal Economy Lifetime Members

28

Indigents (NHTSPR)

55

Sponsored
Member

# of Client's served
during ward
classes, mother's
class, opd
lectures,etc.

Non-Member

11

25

Membership

Contribution

ACAs

Actions Taken:
I informed the
Hospital Philhealth
staff that they must
not force philhealth
member/dependent
to sign in the blank
Statement of
Account. The
member has the
right to view the
detailed SOA
before discharge
Healthcare
to avoid
Provider Relations confusion/misunderstanding.
Benefits
No Balance Billing
I reported this
issue to our task
leader to refer or
mention this
problem in our
anti-fraud legal
team.

All Case Rate

Point of Care

NHTS-PR/4PS

120

shall provide
answers regarding
the eligibility of the
patient. The
generated PBEF
shall be attached
to the claims
replacing the
MDR. I also
instructed them
how useful this
Portal to the
benefits of the
hospital and
philhealth
HCI Portal and
PBEF, i-CARES
members
to save
MCIS
time,and
energy
and
money. They told
me that the
internet connection
of the hospital was
so slow thats why
they still requiring
MDR to philhealth
members.

Internal

Email1 Template
Status[1]

Email1 Template
sent to
acperpetua13@gmail.com
on 06/02/14 at 3:
01:06 PM

1.The hospital is
still obliging the
philhealth
member/dependent
to sign in the blank
Statement of
Account and Claim
Form 2 (CF2) Part
IIIB which means
the drugs and
medicine,
laboratories, room
and board,
professional fees
and others are not
itemized.

AUGUSTO
6/2/2014 15:03:32 CEAZAR

6/2/2014 16:03:49 NAPAGAL

6/2/2014 16:15:23 NAPAGAL

6/2/2014 18:56:41 HARRY JOSEPH

6/2/2014 19:00:58 HARRY JOSEPH

6/2/2014 19:04:57 HARRY JOSEPH

6/2/2014 19:08:36 HARRY JOSEPH

6/3/2014 4:35:16 RIZZA SALVE

6/3/2014 4:57:46 RIZZA SALVE

6/3/2014 5:47:34 EMA LISETTE

6/3/2014 12:43:50 BLESSILE

PERPETUA

DIANA MAY

DIANA MAY

SARTORIO

SARTORIO

SARTORIO

5 acperpetua13@gmail.com
May

5 missdiane16@gmail.com
May

5 missdiane16@gmail.com
May

hjsartorio@gmail.
5 com

hjsartorio@gmail.
5 com

hjsartorio@gmail.
5 com

May

May

May

Roving

Roving

Roving

Roving

Roving

Roving

SANTISSIMA
TRINIDAD
HOSPITAL OF
DAET

5/19-31/2014

ST. JOHN
HOSPITAL, INC.

5/1-17/2014

BICOL
SANITARIUM

5/19-31/2014

LIBMANAN
DISTRICT
HOSPITAL

5/1-10/2014

LIBMANAN
DISTRICT
HOSPITAL

5/1-17/2014

SIPOCOT
DISTRICT
HOSPITAL

5/19-24/2014

Private

Private

Government

hjsartorio@gmail.
5 com

May

Roving

5/26-31/2014

RAGAY DISTRICT
HOSPITAL
Government

LUCERO

rsalucero.
5 rl@gmail.com

May

Roving

5/1-10/2014

STO. NINO
HOSPITAL

LUCERO

MALATE

REBOLLEDO

May

5 elmalate17@gmail.com
May

5 blessilerebolledo@gmail.com
May

Roving

5/12-31/2014

Permanent

Roving

LEON D.
HERNANDEZ
MEMORIAL
HOSPITAL

5/1/2014

5/1-3/2014; 5/1,2,3
/2014

BICOL MEDICAL
5/31/2014 CENTER

MANDAON
MEDICARE
COMMUNITY
HOSPITAL

47

22

42

43

60

60

PCF

Government

Government

10

Government

SARTORIO

rsalucero.
5 rl@gmail.com

11

PCF

PCF

Private

104

Private

83

448

4 NONE
The hospital is
starting to practice
the use of portal
and relying on
what are the only
documents needed
that is asking by
the system in
replace to MDR.
No unnecessary
documents
requiring the
members.

On Records
Department their
transactions are
very transparent.
CARES can freely
observe how the
flow of the claims
448 are process.
1. The hospital
provided the
CARES a
convenient place
to work where
clients will no
longer hesitate to
ask since we are
already situated in
our own office.

12

26

12

14

19

21

10

15

22

13

Government

PCF

1247

1359

NO ISSUE
40 NOTED

NO ISSUE
10 NOTED

NO ISSUE
10 NOTED

16

37

97

NONE

NO ISSUE
15 NOTED

12

23

101

14

324

33

They keep on
asking the
members to submit
updated Member
Data Record
instead of using
PBEF. The
Philhealth Clerk
told me that there
was no available
printer to be use in
printing PBEF. But
on my last day of
duty, they were
already starting to
use PBEF instead
of asking for
documentary
requirements.

169

67

Email1 Template
sent to
acperpetua13@gmail.com
on 06/02/14 at 3:
03:42 PM

2.The Health
Education
Promotion Office
are consistent in
giving information
to the people
about philhealth.
CARES are also
joining in the
information
dissemination in
Out Patient
Department and
Hospital Wards.
Government

100

93

Actions Taken:
I informed the
billing staff that
they must not force
philhealth
member/dependent
to sign in the blank
Statement of
Account. The
member has the
right to view the
detailed SOA
before discharge
to avoid confusion.
I reported this
issue to our task
leader to refer or
mention this
problem in our
anti-fraud legal
team.

In the
ER/Admitting
Department there
is no Portal
installed,so upon
admission the
patient was not
checked if they are
eligible or not to
avail for PHIC
benefits.The client
cannot prepare
earlier the other
documents that will
be needed to avail
PhilHealth
196 benefits.

Non-Members are
encouraged to
register during
information
dissemination. The
importance of
PhinHealth are
emphasized during
OPD and Ward
551 classes.

NO ISSUE
NOTED

NO ISSUE
NOTED

NO ISSUE
NOTED

NO ISSUE
NOTED

NO ISSUE
NOTED

NO ISSUE
NOTED

NO ISSUE
NOTED

NO ISSUE
NOTED

NO ISSUE
NOTED

NO ISSUE
NOTED

NO ISSUE
NOTED

NO ISSUE
NOTED

NO ISSUE
NOTED

NO ISSUE
NOTED

still, they allowed


to sign blank cf2
and blank
statement of
account.

NO ISSUE
NOTED

NBB COMPLIANT
LIBMANAN
DISTRICT
HOSPITAL
still, incomplete
availability of
medicine inside
the facility and
members are
required to bought
outside.
Laboratory like
xrays, blood work
are also being paid
by the member.
LIBMANAN
DISTRICT
HOSPITAL
still, incomplete
availability of
medicine inside
the facility and
members are
required to bought
outside.
Laboratory like
xrays, blood work
are also being paid
by the member.

NO ISSUE
NOTED

NO ISSUE
NOTED

SIPOCOT
DISTRICT
HOSPITAL
still, incomplete
availability of
medicine inside
the facility and
members are
required to bought
outside.
Laboratory like
xrays, blood work
are also being paid
by the member.
no issue noted
RAGAY DISTRICT
HOSPITAL
still, incomplete
availability of
medicine inside
the facility and
members are
required to bought
outside.
Laboratory like
xrays, blood work
are also being paid NO ISSUE
by the member.
NOTED

N/A

Email1 Template
sent to
missdiane16@gmail.com
on 06/02/14 at 4:
15:30 PM

NO ISSUE
NOTED

LIBMANAN
DISTRICT
HOSPITAL
they are not using
it always because
computer are
lacking and the
personel that are
using it are too
busy and a lot of
work to do.

They just inquire


the member to
submit PMRF
especially those
who do not have a
5 updated MDR.
NONE

Email1 Template
sent to
hjsartorio@gmail.
com on 06/02/14
at 7:01:06 PM

N/A

no issue noted

NO ISSUE
NOTED

Email1 Template
sent to
hjsartorio@gmail.
com on 06/02/14
at 7:05:04 PM

NO ISSUE
NOTED

RAGAY DISTRICT
HOSPITAL
they are also not
using portal
because of no
internet
NO ISSUE
connection.
NOTED

Email1 Template
sent to
hjsartorio@gmail.
com on 06/02/14
at 7:08:43 PM

N/A

Email1 Template
sent to rsalucero.
rl@gmail.com on
06/03/14 at 4:35:
31 AM

There is only a
maximum
allocation for
Drugs and
Medicines the
sponsored and
NHTS members
can get from the
hospital pharmacy
so the indigents
still have to
purchase
medicines outside
the hospital.

NONE

NO ISSUE
NOTED

NO ISSUE
NOTED

Not using HCI


Portal regularly,
Only printing PBEF
indicating with a
YES.

they give the


philhealth patients
everything they
need, even if the
supplies are not
enough but they
are trying.

Email1 Template
sent to
hjsartorio@gmail.
com on 06/02/14
at 6:56:48 PM

N/A

Asking for a initial


payment on the
hospital even the
benefits are not
yet utillized.

P-Cares are very


much welcome in
this hospital. they
provide us a safe
room where we
can stay in the
process of our
deployment in their
hospital.

NO ISSUE
NOTED

LIBMANAN
DISTRICT
HOSPITAL
they are not using
it always because
computer are
lacking and the
personel that are
using it are too
busy and a lot of
work to do.
SIPOCOT
DISTRICT
HOSPITAL
they are not using
it because they do
not have internet
connection. they
have pocket wifi
but do not always
have an internet
load. Budget for
internet load are
coming from their
own pocket
expenses and not
from the local
government of
cam sur. That's
according to them.

The hospital is still


asking for the copy
of receipts
payment or
certification of
contribution even
the member is
eligible to avail the
benefit as
indicated to the
portal. For the
employed,they still
ask for the RF1 or
certificaton of
payment from the
employer even the
CF1 Part IV is
properly flled up.

Sponsored
members were
happy that they
can still pay and
renew their
philhealth
membership.

Email1 Template
sent to
missdiane16@gmail.com
on 06/02/14 at 4:
03:56 PM

The Point of Care


enrollment
program in Bicol
Sanitarium was
temporarily on hold
because there was
an issue and order
from Commission
on Audit (COA).

it is not properly
implemented but
they are tying. lack
of supplies is the
main reason and
the capitol is
holding the budget
and supplies.
none

BMC has a 48-72


hour policy where
patients can only
be enrolled under
point of care if
he/she is not
admitted over 72
hours. There are
only instances
where they
consider clients to
be enrolled under
point of care even
they have already
exceeded the said
number of hours.

none

Email1 Template
sent to rsalucero.
rl@gmail.com on
06/03/14 at 4:57:
54 AM

Email1 Template
sent to
elmalate17@gmail.com
on 06/03/14 at 5:
47:44 AM

none

the user is not


really familiar yet
and they donnot
use PBEF until i
came and
encouraged them
to use the portal
for patients
verification

Email1 Template
error: Exception:
the cares is a big Service invoked
help for them, they too many times for
said.
one day: email.

Timestamp

FIRST NAME

6/3/2014 12:44:43 DONNA

LAST NAME

PEREZ

Region

Email Address

Reporting Month

5 dyemmonroe@gmail.com
May

CARES Status

EXAMPLES: 8/115/2014 ; 8/1,


3,5,6,10/2014

From

To

Name of Facility

Hospital Category

Roving

5/1-10/2014; 5/1217/2014; 5/1931/2014

AROROY
MUNICIPAL
HOSPITAL

CATAINGAN
DISTRICT
HOSPITAL

Government

Government

Government

6/3/2014 12:56:37 BLESSILE

REBOLLEDO

5 blessilerebolledo@gmail.com
May

Roving

5/5-17/2014; 5/5,
6,7,8,9,10,12,13,14,15,16,17/2014

6/3/2014 13:00:08 DONNA

PEREZ

5 dyemmonroe@gmail.com
May

Roving

5/12-17/2014;
5/12,
13,14,15,16,17
/2014

BALUD
MUNICIPAL
HOSPITAL

CAWAYAN
DISTRICT
HOSPITAL

Government

PhilHealth
employees has its
52 own room.

Government

356

1359

Private

PEREZ

5 dyemmonroe@gmail.com
May

Roving

5/19-31/2014;
5/19,
20,21,22,23,24,26,27,28,29,30,31/2014

TICAO DISTRICT
HOSPITAL

Government

6/3/2014 14:01:55 SHANNY

OAFERINA

sha.
gush11@gmail.
5 com

Permanent

5/1/2014

BICOL MEDICAL
5/31/2014 CENTER

IBARRIENTOS

jocelleibarrientos.
5 ji@gmail.com

6/3/2014 22:02:42 JUVY

CONCINA

5 concinajuvy718@gmail.com
May

Permanent

6/3/2014 22:06:38 JOCELLE

IBARRIENTOS

jocelleibarrientos.
5 ji@gmail.com

Roving

May

5/2/2014

USI-MOTHER
SETON
5/31/2014 HOSPITAL

NAGA CITY
HOSPITAL

8/19-31/2014

PCF

52

6/3/2014 13:19:44 DONNA

5/2-17/2014

NONE
All claims has
been properly
organized. They
also have a
logbook for their
clients. Inquiries
are easily
answered due to
proper organizing
of files.

21

Roving

Roving

5 blessilerebolledo@gmail.com
May

May

None

54

REBOLLEDO

6/3/2014 16:10:26 JOCELLE

PCF

Hospital's Best
Practices

81

6/3/2014 13:07:44 BLESSILE

NICC NAGA
DOCTORS
HOSPITAL

No. of
member/dependent
who are able to
avail of the
benefits

The hospital is like


a private hospital
because they have
enough supplies
for the patient to
use like drugs and
54 medicines.

5/19-31/2014;
5/18,
20,21,22,23,24,26,27,28,29,30,31/2014

May

No. of NonPhilHealth
No. of PhilHealth
member/dependent member/dependent

Hospital Level

PCF

1359

Formal Economy

Informal Economy Lifetime Members

Indigents (NHTSPR)

10

Sponsored
Member

# of Client's served
during ward
classes, mother's
class, opd
lectures,etc.

Non-Member

Membership

13 None
The hospital
required the
philhealth patient
or member to
provide or to Fillup PMRF,
especially if they
don't have a
30 updated MDR.

Contribution

ACAs

the hospital still


requiring the IPM
the old rules the
9/12. but i have
already told them
that we have a
new rules which is
the 3/6.
none

i dont really feel


that the cares are
really welcome in
this hospital.

the patient cannot


avail his benefits
beacuse of lack of
supplies and
funds.

NBB policy are not


properly
implemented,
because they do
not have supplies
like in laboratories
and also the drugs
and medicines.
none

None

31

8 None

None

None

None

52

20 none

none

none

they provide us a
safe room where
we can stay for the
period of our duty
in their hospital
none

126

38 None

None

None

None

88

72

21

285

104

42

280

88

59

18

245

614

614

180

118

62

36

Government

92

34

34

26

11

12

14

55

6/4/2014 9:50:24 JESSICA

6/4/2014 10:12:12 MARVIN

SANTOS

ESCARIO

5 jeckasantos@gmail.com
May

5 jeckasantos@gmail.com
May

5 escariomarvin@gmail.com
May

Roving

Roving

Roving

LABO DISTRICT
HOSPITAL

5/1 -17/2014

CAPALONGA
MEDICARE AND
COMMUNITY
HOSPITAL

5/19 - 31/2014

Government

Government

DR FERNANDO B
DURAN SR
MEMORIAL
HOSPITAL
Government

5/1-31/2014

6/4/2014 10:28:20 BILLY JOEL N.

BAILO

5 bjbailo@gmail.com April

Permanent

5/1/2014

JOSEFINA
BELMONTE
DURAN
MEMORIAL
DISTRICT
5/31/2014 HOSPITAL

6/4/2014 14:08:00 DIEZMO

JAYRON

5 diezmojayron@gmail.com
May

Permanent

5/2/2014

CAMARINES
NORTE
PROVINCIAL
5/31/2014 HOSPITAL

PCF

12

12

499

21

625

520

92

44

16

51

26

413

22

60

17

27

338

All Case Rate

None

None

11

Private

No Balance Billing

None

None

None

Robinsons Bank
Naga branch still
collected 450
pesos as quarterly
Philhealth
premium
contribution for
informal category.

Action taken:
I have talked about
the issue to the
Administrative
Officer of the
hospital. She
explained that they
dont have
personnel
(radiologist) that
can read the result
of Xray of patients.
Because of this
they need to bring
the films to Daet
where it can be
read by a
radiologist. I had
reminded them
that this kind of set
up has violated the
NBB Policy for
Indigent members.
She made an
assurance that
they are making an
effort to solve this
problem. She
stated that she had
a proposal where
they will have a
cash advance
budget for
philhealth
members who will
undergo an Xray.

Once the patient


was admitted and
was categorized
as nonmed, I took
time to interview
the
patient/watcher,
getting all the
information that
might be needed
for member search
in i-cares. I had
made sure that the
patient is really not
an active member
or a valid
dependent. Once
the member has
been verified to be
an active member,
I had assisted
them to avail the
benefits they are
entitled to.
Information was
also given to them
about the benefits
like NBB Policy
and the validity of
20 their membership.
I have found out
that there are
some clients (in
patients and out
patients) that
werent aware that
they are an active
member of PHIC
under the Indigent
(NHTS-PR)
Program and can
avail an outright
benefit in the
hospital. Through
sending of text
message at
CAREs command
center, the validity
of membership
was verified.

No Balance Billing
has not been
applied yet. No
budget from the
provincial
government yet.
None
the NBB policy is
properly
implemented in
their hospital. they
have enough
supplies, drugs
and medicines for
the philhealth
patients.
none
No balance billing
has not been
properly applied.
Medicines were
still bought outside
the hospital.
None

Not applicable

The hospital is still


asking payment
(P50) for Xray
reading.

Action taken:

SANTOS

Benefits

No Balance Billing
is not properly
applied in the
hospital.
None

I have found out


that there are
some clients that
werent aware that
they are an active
member of PHIC
under the Indigent
(NHTS-PR)
Program and can
avail an outright
benefit in the
hospital. Through
i-cares, the validity
of membership
was verified.

6/4/2014 9:41:51 JESSICA

Healthcare
Provider Relations

None

None

HCI Portal and


PBEF, i-CARES
and MCIS
Internal
The hospital's HCI
portal has expired
last January 2014. The CARES
and has not been lighten up their
visited yet by
work and were a
PhilHealth staff.
big help for them.

none

none

they do not have a


portal yet because p-cares is a big
the signal is very
help for this
low in their area
hospital

Email1 Template
error: Exception:
Service invoked
too many times for
one day: email.

None

None

No HCI portal. No
internet
connection.

Email1 Template
error: Exception:
Service invoked
too many times for
one day: email.

none

none

none

None

None

No HCI portal and


PBEF yet.
None

Point of Care

NHTS-PR/4PS

some client
comparing the fee
for service is better
from all case rates
because of
reduction in
benefit.

Email1 Template
error: Exception:
Service invoked
too many times for
one day: email.

Email1 Template
error: Exception:
Service invoked
too many times for
one day: email.
Email1 Template
error: Exception:
Service invoked
too many times for
one day: email.
Email1 Template
error: Exception:
Service invoked
too many times for
one day: email.
Email1 Template
sent to
jocelleibarrientos.
ji@gmail.com on
06/03/14 at 4:10:
34 PM

Email1 Template
sent to
concinajuvy718@gmail.com
on 06/03/14 at 10:
02:50 PM
Email1 Template
sent to
jocelleibarrientos.
ji@gmail.com on
06/03/14 at 10:06:
45 PM

still not
implemented
The hospital is a
provider of Animal
Bite Treatment
Package. I have
found out that they
The hospital is
dont have an
available RIG and still not NBB
the
compliant. The
members/beneficiaries
client is needs to
who need this
buy outside if the
were being
referred to private prescription is not
institutions. They available in the
were just advised hospital pharmacy.
to secure Official
Action taken:
receipt for
I have talked to the
Philhealth refund. Administrative
Officer about the
Action taken:
concern. She had
I had talked to the coordinated with
concerned
their therapeutic
personnel about
committee to solve
the concern. I
the problem. She
reminded them
reminded them
that the NBB
that as much as
Policy was being
possible the
violated. They had medicines that will
explained that the be prescribed are
said medicine was available in the
once available in
hospital pharmacy.
the hospital but
But there are still
since they had
certain
changed their
circumstances that
medicine supplier, the client needs to
it hasnt been
buy medicines
readily available.
outside. I had
They had made an advised the client
assurance that
that they should
they are making
secure an official
their effort to solve receipt for a
this problem. But refund. I already
for the meantime, have suggested to
they had assured the Administrative
that the official
officer that they
receipt that has
may have a
been secured by
consignment to the
the member will be outside
refunded once the pharmacies for the
claim has been
Indigent members
paid.
benefit.

Action taken:
Once the patient
was admitted and
was categorized
as nonmed, I took
time to interview
the
patient/watcher,
getting all the
information that
might be needed
for member search
in i-cares. I had
made sure that the
patient is really not
an active member
or a valid
dependent. Once
the member has
been verified to be
an active member,
I had assisted
them to avail the
benefits they are
entitled to.
Information was
also given to them
about the benefits
like NBB Policy
and the validity of
their membership.
Same was done to
outpatient client
that has been
40 encountered.

None

Email1 Template
Status[1]

In my first week at
the hospital, the
clerk is asking the
old documentary
requirements for
benefit availment.
The reason they
are doing this is
that their computer
with portal installed
had encountered a
problem.
Action taken:
Reminded the
hospital personnel
on how efficient it
will be both for the
member and the
hospital if they are
just printing PBEF.
The hospital had
their CPU brought
to PRO for
reinstallation of
portal. HCIP Portal
has been
completely utilized
again.

Email1 Template
sent to
jeckasantos@gmail.com
on 06/04/14 at 9:
41:59 AM

The hospital is still


not NBB
compliant. The
client needs to buy
medicines outside
because of
insufficiency of
supply in the
hospital.
Action taken:
I have talked to the
hospital chief
about the concern.
She explained that
the medicines and
supplies were
already for pick up
in Daet. She also
explained that they
are making a
proposal for a
consignment to a
certain pharmacy
to avoid violating
the NBB Policy. I
had advised the
members to
secure official
receipt so that they
may have the
chance to refund
their out of the
pocket expenses.
THEY DO NOT
INCLUDE A
SYRINGE AS
INCLUDED IN
MEDICAL
SUPPLY TO BE
PAID BY
PPHILHEALTH
SO IF THERE A
PRESCRIPTION
THEY OBLIGE TO
BUY IT.

963

Government

370

158

158

10

14

78

42 NONE

NONE

NONE

NONE

Government

1738

719

719

56

191

10

307

13

36 NONE

NONE

NONE

NONE

NONE

NOT FULLY
IMPLEMENTED,
ALMOST OUT OF
POCKET
EXPENSES
ESPECIALLY IN
MEDICINE AND
LABORATORY
The hospital
cannot provide all
the necessary
medicines and
laboratory
necessary for
NBB.
NONE
NBB NOT FULLY
IMPLEMENTED
BECAUSE OF
OUT OF POCKET
EXPENSES

Enhanced IHCP
portal is still not
utilized. Their
reason is that until
now the modem
they needed is still
not delivered.
Action taken:
I have reemphasized the
importance of
printing PBEF for
both the hospital
and the members.

NOT
IMPLEMENTED

NONE

NOT YET
IMPLEMENTED

NONE

THEY ARE NOT


USING PBEF FOR
THE REASON OF
NO SIGNATORY
AND THEY
SYSTEM WAS
REFORMAT.
The hospital uses
PBEF for checking
of eligibility
however due to
lack of ink/toner for
the printer, printing
of PBEF is a
problem.

Email1 Template
sent to
jeckasantos@gmail.com
on 06/04/14 at 9:
50:32 AM

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sent to
escariomarvin@gmail.com
on 06/04/14 at 10:
12:19 AM

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sent to
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on 06/04/14 at 10:
28:28 AM
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sent to
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on 06/04/14 at 2:
08:07 PM

Timestamp

FIRST NAME

LAST NAME

Region

Email Address

Reporting Month

CARES Status

EXAMPLES: 8/115/2014 ; 8/1,


3,5,6,10/2014

From

To

Name of Facility

Hospital Category

No. of NonPhilHealth
No. of PhilHealth
member/dependent member/dependent

Hospital Level

6/4/2014 18:47:16 ARLENE

AONUEVO

arlene.
anonuevo@gmail.
5 com
May

Roving

5/2-3/2014

DONSOL
DISTRICT
HOSPITAL

Government

6/4/2014 18:51:27 ARLENE

AONUEVO

arlene.
anonuevo@gmail.
5 com
May

Roving

5/5-10/2014

VICENTE L.
PERALTA
MEMORIAL
HOSPITAL

Government

6/4/2014 18:58:56 JOVEN

ALDEA

aldjoven13@gmail.
5 com
May

Permanent

BICOL REGIONAL
TRAINING AND
TEACHING
5/31/2014 HOSPITAL
Government

6/4/2014 19:02:06 ARLENE

6/4/2014 19:06:42 ARLENE

6/4/2014 19:16:24 ARLENE

6/4/2014 19:57:21 ROSS AUREA

6/5/2014 0:19:02 CYRILL

AONUEVO

AONUEVO

AONUEVO

VALEZA

BRONCANO

arlene.
anonuevo@gmail.
5 com
May

arlene.
anonuevo@gmail.
5 com
May

arlene.
anonuevo@gmail.
5 com
May

5 rossaureavaleza06@gmail.com
May

5 cyrillcares04@gmail.com
May

Roving

Roving

Roving

5/1/2014

5/12-17/2014

MAGALLANES
MEDICARE
COMMUNITY
HOSPITAL

5/19-24/2014

5/1/2014

5/2,3,5,6,7,8,9,10
/2014

Government

Government

IROSIN DISTRICT
HOSPITAL
Government

5/26-31/2014

Permanent

Roving

MATNOG
MEDICARE
COMMUNITY
HOSPITAL

EASTERN BICOL
MEDICAL
5/31/2014 CENTER
Government

TANCHULING
GENERAL
HOSPITAL

Private

No. of
member/dependent
who are able to
avail of the
benefits

PCF

784

1107

1107

PCF

Hospital's Best
Practices

Formal Economy

618

218

142

382

102

382

Sponsored
Member

# of Client's served
during ward
classes, mother's
class, opd
lectures,etc.

Non-Member

Membership

14

46

68

49

44

193

79

11

Indigents (NHTSPR)

Indigent members
of far flung places
are having
difficulties in
getting an updated
MDR because of
its geographical
location from the
nearest Philhealth
office. It is also
equally hard for
them to know
whether or not
they still have an
active
membership.
Being far from the
nearest Philhealth
office makes it
hard for paying
members
contribution and
enrolling for non16 members.

PCF

Informal Economy Lifetime Members

10

26

16

24

20

21

35

76

18

66

13

Contribution

ACAs

Healthcare
Provider Relations

Benefits
1) Philhealth
members
especially
indigents have to
pay their hospital
bills for them to be
discharged from
the facility during
weekends. They
are then asked to
come back and
submit their
Philhealth
requirements
during weekdays
for reimbursement;
this resulted to
more complaints
and additional
burden because
they have spent
already their
money for
unavailable
medicines,
laboratories and
diagnostic
procedures inside
the facility.

All Case Rate

Point of Care

NHTS-PR/4PS

No Balance Billing
is not fully
implemented in the
facility because of
out-of-the-pocket
expenses incurred
by
members/dependents
for medicines,
2) Newborn
laboratory, and
Screening test is
diagnostic
not available inside procedures during
the facility.
hospitalization.
Pilhealth members
especially
indigents have to
pay their hospital
bills for them to be
discharged from
the facility during
weekends. They
are then asked to
come back and
submit their
Philhealth
requirements
during weekdays
for reimbursement;
this resulted to
No Balance Billing
more complaints
is not fully
and additional
implemented in the
burden because
facility because of
they have spent
out-of-the-pocket
already their
expenses incurred
money for
by
unavailable
members/dependents
medicines,
for medicines,
laboratories and
laboratory, and
diagnostic
diagnostic
procedures inside procedures during
the facility.
hospitalization.
Sponsor member
still have bought
meds/drugs
outside the
hospital. NBB is
not fully achieved

Members are
having difficulties
in getting an
updated MDR
because of its
geographical
location from the
nearest Philhealth
office. It is also
equally hard for
them to know
whether or not
they still have an
active
membership.
Being far from the
nearest Philhealth
office makes it
hard for paying
members
contribution and
enrolling for non34 members.
Members are
having difficulties
in getting an
updated MDR
because of its
geographical
location from the
nearest Philhealth
office. It is also
equally hard for
them to know
whether or not
they still have an
active
membership.
Being far from the
nearest Philhealth
office makes it
hard for paying
members
contribution and
enrolling for non50 members.

HCI Portal and


PBEF, i-CARES
and MCIS

Internal

Email1 Template
sent to arlene.
anonuevo@gmail.
com on 06/04/14
at 6:51:34 PM

Date of discharge
cannot be edited
once PBEF is
generated.

Email1 Template
sent to
aldjoven13@gmail.
com on 06/04/14
at 6:59:04 PM

The facility is not


yet utilizing the
Philhealth portal,
thus members still
have to secure an
updated MDR.

Email1 Template
sent to arlene.
anonuevo@gmail.
com on 06/04/14
at 7:02:14 PM

No Balance Billing
is not fully
implemented in the
facility because of
out-of-the-pocket
expenses incurred
by
members/dependents
for medicines,
laboratory, and
diagnostic
procedures during
hospitalization.

Email1 Template
sent to arlene.
anonuevo@gmail.
com on 06/04/14
at 7:06:49 PM

1) Philhealth
members have to
pay their hospital
bills for them to be
discharged from
the facility during
weekends. They
are then asked to
come back and
submit their
Philhealth
requirements
during weekdays
for reimbursement;
this resulted to
more complaints
and additional
burden because
they have spent
already their
money for
unavailable
medicines,
laboratories and
diagnostic
procedures inside
the facility.
2) Members are
ask to sign blank
forms.
3) Members
complained that
reimbursements of
their expenses
during
hospitalization take
a lot of time
although they
received their
Benefit Payment
Notice for some
time already.

N/A

N/A

N/A

No Balance Billing
is not fully
implemented in the
facility because of
out-of-the-pocket
expenses incurred
by
members/dependents
for medicines,
laboratory, and
diagnostic
procedures during
hospitalization.
NBB is not
properly
implemented in
this hospital. The
members still
endure out of
pocket expenses
which include
medicines, suplies
and laboratory.
The philhealth
clerk does not
attach all receipts
in the patients
claim, they just
compute the total
bill then minus it to
the amount of case
rate if there are still
remaining amount
for the
reimbursement
then they will
reimburse it to the
member.

N/A

No concerns
noted.

Email1 Template
Status[1]

Email1 Template
sent to arlene.
anonuevo@gmail.
com on 06/04/14
at 6:47:23 PM

No Balance Billing
is not fully
implemented in the
facility because of
out-of-the-pocket
expenses incurred
by
members/dependents
for medicines,
laboratory, and
diagnostic
procedures during
hospitalization.

Membes are
having difficulties
in getting an
updated MDR
because of its
geographical
location from the
nearest Philhealth
office. It is also
equally hard for
them to know
whether or not
they still have an
active
membership.
Being far from the
nearest Philhealth
office makes it
hard for paying
members
contribution and
enrolling for non71 members.

Members were
required with
supporting
documents
evwnthough it is
indicated in the
Philhealth Circular
that a properly
filled up PMRF is
enough in
enrollment and
updating. So some
patients have a
hard time in
completing the
required
documents
especially those
36 indigent members.
> Hospital
PhilHealth Staff
continuously
demand all clients
to submit copies of
birth certificates,
marriage contracts
etc. despite having
an updated MDR.
This has been long
reported to PRO
for necessary
0 action.
N/A

No Balance Billing

N/A

An employed
member has a
Member Data
Record at hand
with his father as
dependent but
generated in 2012.
The Philhealth
clerk checked the
eligibility of the
member but the
portal showed that
the member has to
update and add his
father as
dependent. But
Some 4PS
upon verification in
members are still ICARES and
not aware that they MCIS, both
are entitled to avail showed that his
of Philhealth
father is a valid
benefits.
dependent.

Email1 Template
sent to arlene.
anonuevo@gmail.
com on 06/04/14
at 7:16:32 PM

Some NHTS
members were
required to update
their philhealth if
the patient is not
yet a declared
dependent. Some
have a hard time
providing the
required document
especially when
their house is far
from the hospital
and if they dont
have the required
documents.

The hospital does


not print the PBEF
if the portal says
No to the eligibility
of the member.
They require the
members to
present an
updated MDR so
they can avail the
philhealth benefit.

Email1 Template
sent to
rossaureavaleza06@gmail.com
on 06/04/14 at 7:
57:29 PM

No concerns
noted.

HCI Portal is
properly utilized
any encountered
errors are duly
forwarded to
PRO5-IT for
assistance.

No concerns
noted.

Email1 Template
sent to
cyrillcares04@gmail.com
on 06/05/14 at 12:
19:11 AM

Timestamp

FIRST NAME

6/5/2014 0:33:14 CYRILL

6/5/2014 10:10:39 YORCK

6/5/2014 10:35:19 YORCK

LAST NAME

Region

Email Address

Reporting Month

CARES Status

EXAMPLES: 8/115/2014 ; 8/1,


3,5,6,10/2014

BRONCANO

5 cyrillcares04@gmail.com
May

Roving

5/12,
13,14,15,16,17
/2014

BONZON

5 YORCKBONZON@GMAIL.COM
May

Roving

5/1-17/2014

BONZON

5 YORCKBONZON@GMAIL.COM
May

Roving

5/19-24/2014

From

To

Name of Facility

Hospital Category

MANITO
MUNICIPAL
HOSPITAL

Government

AGO GENERAL
HOSPITAL

Private

CAGRARAY
DISTRICT
HOSPITAL

Government

No. of NonPhilHealth
No. of PhilHealth
member/dependent member/dependent

Hospital Level

PCF

PCF

No. of
member/dependent
who are able to
avail of the
benefits

Hospital's Best
Practices

Formal Economy

Informal Economy Lifetime Members

Indigents (NHTSPR)

Sponsored
Member

# of Client's served
during ward
classes, mother's
class, opd
lectures,etc.

Non-Member

Membership

> No issues
9 encountered.

15

13

65

19

Contribution

> The distance of


the hospital to the
nearest LHIO and
ACA posed great
difficulty to
members who
wish to pay their
premium
contributions.

ACAs

None.

Healthcare
Provider Relations

None.

Benefits

None.

No Balance Billing

All Case Rate

Poorly
implemented due
to lack of supplies
for drugs and
medicines. A lot of
out of pocket
purchases has
been incurred by
the members.
None.

NBB monitoring is
not possible
because there are
only 2 patients
during the CARES
hospital stay. The
first patient is a
non member and
the other one is
not yet discharged
when the CARES
left the facility.

Point of Care

None.

NHTS-PR/4PS
> 4P's members
confined in the
hospital most of
the times find it
difficult to secure
Municipal Link
Certificate due to
distance of the
facility to the
MSWDO. Most
4P's in Manito do
not have 4P's ID
yet.

HCI Portal and


PBEF, i-CARES
and MCIS

Internal

HCI Portal was


never used during
my deployment in
Manito, mostly due
to very poor
internet
connection.
None.
There are times
that IHCP portal
has slow
connection or
unable to generate
PBEF as a result
they tend to delay
discharges.
However, as a
remedy, they ask
the member to
sign on a blank
sheet of paper and
this will be used
when generation of
PBEF is already
possible. I have
informed the Billing
and PhilHealth
officers that such
act is not
appropriate yet if
there are no other
options, maybe
they may do such
but be sure to
inform the PRO
and the member.
Also, during my
stay, whenever
they encounter
slow connection,
issuance of PCF 1
plays an important
function.
This facility is
categorized as
Primary Care
Facility and
currently, there is
There is a limited only one doctor
signal both on
who is the Chief of
smart and globe
Hospital as well.
network so there
Whenever there
portal was installed are seminars, no
in the main land of resident on duty is
Bacacay, Albay far left therefore there
from the island of will be no
Cagraray.
admissions.

Email1 Template
Status[1]

Email1 Template
sent to
cyrillcares04@gmail.com
on 06/05/14 at 12:
33:22 AM

Email1 Template
sent to
YORCKBONZON@GMAIL.COM
on 06/05/14 at 10:
10:47 AM

Email1 Template
sent to
YORCKBONZON@GMAIL.COM
on 06/05/14 at 10:
35:28 AM

1. Don't change the name of this column. It is used to log the send status of an email template, whose name must be a match.