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Timestamp

First Name

3/27/2014 9:44:35 CENTRAL

Last Name

ZUBIRI

3/29/2014 11:13:
32 JOHN RAYMOND DUMANDAN

3/31/2014 19:00:
40 MA.VERONICA

4/2/2014 10:56:37 SHIELA ANNE

CUYA

GOLIPATAN

Region

Email Address

Status

NCR

laidocaine@gmail.
com
Permanent

NCR

dumandan.
raymond@gmail.
com

NCR

NCR

Permanent

roni924ph@yahoo.
com
Permanent

sagolipatan@gmail.com
Permanent

Hospital Covered

D
AMANG
RODRIGUEZ
MEMORIAL
MEDICAL
CENTER

QUIRINO
MEMORIAL
MEDICAL
CENTER

LUNG CENTER
OF THE
PHILIPPINES

Hospital Category

PERMANENT
START

Hospital Level

PERMANENT
END

ROVING

Formal Economy

Informal Economy Lifetime Members

Indigents (NHTSPR)

Sponsored
Member

# of Client's served
No. of
during ward
member/dependent
classes, mother's
No. of Nonwho are able to
class, opd
PhilHealth
No. of PhilHealth
avail of the
lectures,etc.
member/dependent member/dependent
benefits

Non-Member

Government

3/14/2014

3/29/2014

Government

3/1/2014

3/31/2014

82

73

22

17

13

Government

Government

3/1/2014

3/1/2014

3/31/2014

3/31/2014

168

127

139

113

39

97

18

80

26

21

48

50

45

547

659

289

506

1263

323

4/2/2014 10:38:32 SHIELA ANNE

GOLIPATAN

NCR

sagolipatan@gmail.com
Permanent

LUNG CENTER
OF THE
PHILIPPINES

Government

3/1/2014

3/31/2014

127

113

39

18

26

48

45

289

323

4/2/2014 11:26:08 MICHELLE

ANCHETA

NCR

michelleancheta092@gmail.com
Permanent

FAR EASTERN
UNIVERSITYNRMF

Private

3/1/2014

3/31/2014

59

22

87

713

1263 NONE

KRISH.
BUMAGAT@GMAIL.COM
Permanent

UNITED
DOCTORS
MEDICAL
CENTER

Private

3/1/2014

3/31/2014

52

32

12

93

186

138

4/2/2014 11:41:51 MICHELLE

ANCHETA

NCR

michelleancheta092@gmail.com
Permanent

MARIKINA
VALLEY MEDICAL
CENTER
Private

3/1/2014

3/31/2014

60

22

87

713

1052

4/2/2014 15:18:37 Rezhiel

Paz

PHILIPPINE
ORTHOPEDIC
CENTER

3/1/2014

3/31/2014

127

82

19

40

12

75

401

169

rezhielpaz19@gmail.com
Permanent

National Kidney
and Transplant
Institute

Private

3/1/2014

3/27/2014

78

22

139

39

Private

3/1/2014

3/31/2014

58

107

23

11

13

158

Ibay

NCR

dhodjie.
md@gmail.com

Permanent

Unciano Medical
Ceenter

4/3/2014 10:04:43 SINDAO

JEANELYN

NCR

sindaojean@gmail.
com
Permanent

STA. TERESITA
GENERAL
HOSPITAL

MADLA

NCR

Jose Isidoro
4/2/2014 19:40:52 Diosdado

4/3/2014 12:26:59 LEO ROSE

Government

NCR

leorosemadla14@gmail.com
Permanent

DELOS SANTOS
MEDICAL
CENTER

Government

Private

3/1/2014

3/1/2014

3/31/2014

3/31/2014

47

105

80

60

22

18

301

46

859

417

Contribution

ACAs

Healthcare
Provider Relations

Benefits

NONE

N/A

NONE

N/A

nbb compliant
NBB COMPLIANT.
SOMETIMES
MEDICINES AND
SUPPLIES THAT
ARE NOT
AVAILABLE IN
THE HOSPITAL
ARE BOUGHT
OUTSIDE.
MEMBERS ARE
ADVISED TO
KEEP THEIR
RECEIPTS AND
INFORMED BY
BILLING CLERKS
THAT WILL BE
REIMBURSE AS
SOON AS THE
CLAIMS ARE
PAID BY
PHILHEATH.
NONE

NONE

N/A

Since NOT ALL


patients know at
times that they
were renewed or
enroll under such
program they were
confusion re:igroup the ones who
if within validityor purchased meds at
3/6
first.

N/A

Since patients
doesnt know at
times that they
were renewed or
enroll under such
program they were
confusion re:igropu the ones who
if within validityor purchased meds at
3/6
first.

N/A

N/A

N.A.

MEMBER PAID
AN AMOUNT OF
900 PHP AT ST.
MARTIN OF
TOURS COOP
DEVELOPMENT
FOR THE THIRD
AND LAST
QUARTER OF
THE YEAR 2013
HOWEVER
THERE IS NO
APPLICABLE
MONTH ON THE
OFFICIAL
RECEIPT AND
THE ONLY
POSTED
CONTRIBUTION
IS FROM
OCTOBER TO
DECEMBER 2013.
BASED ON THE
ICARES MEMBER
IS ELIGIBLE.
RESOLVED.
N.A.

All Case Rates

On site Point of
Care

Internal

POINT OF CARE
IS SUSPENDED
STARTING
MARCH 11,2014.
COPY OF
COMMISSION ON
AUDIT REPORT
IS FORWARDED
TO TEAM
LEADER.
NONE

PBEF PRINTING
cannot be
implemented. no
printer and access they are not
to printer avail in
implementing it
the hosp.
still.

UNIFORMS!!!
CORPORATE
UNIFORMS!!!
SUPPLIES!!!
Flyers.
Trainings and
snacks during OB
or meetings since
we funds for
PCARES use. :)

PBEF cannot
implement. no
printer and access they are not
to printer avail in
implementing it
the hosp.
still.

UNIFORMS!!!
CORPORATE
UNIFORMS!!!
SUPPLIES!!!
Flyers.
Trainings and
snacks during OB
or meetings since
we funds for
PCARES use. :)

THERE WAS AN
INCONSISTENCY
WITH THE MDR
AND THE PBEF.
CHENG,
FRANCISCO KOK
KING
PRESENTED AN
MDR WITH HIS
DEPENDENT'S
DATA. THE
DEPENDENT'S
BIRTHDATE IS
SEPTEMBER 19
ON THE MDR,
HOWEVER WHEN
CHECKED ON
THE PBEF, THE
BIRTHDATE IS
SEPTEMBER 9.
THE MDR WAS
ALSO THE SAME
WITH ICARES
DATA.. MANUAL
PROCESS WAS
DONE.
RESOLVED.
N.A.

N.A.

nbb compliant

N.A.

N.A.

N.A.

NBB compliant

1. Passing of
requirements
ahead of time. 3D
for Manila based
and 5D for
provincial based
patients.
2.upon admission with the sue of HCI
portal eligibility is
checked but
PBEFS is not yet
generated only
viewed.
3. Progressive checking of
requirements of
inpatient done
during ward visit
and also checking
of chart done by
billing clerks to
check if the case
of patient is
compensable and
if not relative or
patient is advised
to transfer to
charity for the
meantime.
4. OPD / ER is
screened and
given stub so as
OR FEE will be
75 discounted.
n/a
Upon admission
the members were
advised to
complete their
PhilHealth
requirements and
forward it to
PhilHealth Section
1 day before
discharge so the
member can have
time to provide all
the lacking
requirements seen
upon evaluation of
859 hospital's staffs.
N/A
Good information
dissemination on
admission and on
discharge of PHIC
in-patients.
Adheres to the IRR
39 of 2014.
No Issues.

n/a

n/a

Same issues,
ACAs receipts
were not accepted
by some hospital
staff unless I
validate it thru
iCARES and sign
the receipts.
N/A

No issues.

N/A

N/A

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Slow internet
connection @
MSW's Portal. thus
massive
enrollment is not
done.
Ward to ward visit
is encouraged, but
question regarding how about visits to
FUND resource is isolated clients, will
raised by
there be hazard
Accounting dept
allowance be
and Audit dept of given? (i.e TB, and
Hospital.
other airborn dse.

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N/A

N/A

Not yet
implemented
although I checked
the system and it
was already
working. MSSD
Head said that
they will ask the
help of EAMC help
in using the
system.
N/A

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No issues.

Private Companies
Need To Inform
Employees Of
PHIC updates,
most specially
those from the
Rizal area.
None.

no internet
provided for
system of cares.

Compliant

N/A
Difficulty in looking
for the ICD's due
to the groupings.
Smaller
compensation as
compared to the
former set-up.

Not applicable

none

The hospital do not


reimburse.

N/A

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Status[1]
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raymond@gmail.
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PBEF
LOOPHOLES.
1. no eligibility nor
requirements
reflected - sample
copy was given to
TL -Ivy.
2.Contri of
Voluntary
members done in
ACAs is not
recognized by the
database thus they
Implants, meds
are tagged as NOT
and other supplies eligible to claim.
are brought by
3. OFW client
patient. NBB
whose validity
survery was
ended is still
conducted and
ELIGIBLE as per
documentation
system. - advised
were forwarded to client to pay to
TL. to sum it,
nearest LHIO for
Generally client's continuation.
feedback on the
4. Declared @
questionnaire is
Icares but
that meds,
Invalid/Undeclared
supplies are out of Dependent on
pocket expenses PBEF
bec it's not
available on the
Cares still provides
hosp's pharmacy . internet
Official receipt are connection. so
safely kept by
when cares is not
Philhealth unit
around there's no
upon d/c , If
PBEF generation
Philhealth pays the since it is a shared
claim that's the
PC.
time the hospital
case
will reimburse only SCI and Fractures
compensability of PNDF drugs of
still not
SCI and Fractures. NBB patient.
compensable.

They implement
158 the use of PBEF.

320

No Balance Billing

NONE

1052

NCR

agenevesyfernandez@gmail.com
Permanent

NONE

323 N/A
N/A
Upon admission,
they arealready
screening patients
re: status of
philhealth so that
they can educate
them what are the
requirements
needed or if the
patient can be part
323 of the NBB policy. n/a

BUMAGAT

NCR

Membership

506

4/2/2014 12:00:04 KRIZIA MERL

4/2/2014 12:39:44 ATHENA GENEVE SYFERNANDEZ

Hospital's Best
Practices

N/A

N/A

N/A

DELOS SANTOS
MEDICAL
CENTER is not yet
using PBEF due to
lack of internet
connections, the
section head is
already
coordinating with
the I.T. department
of the said
hospital.
N/A

N/A

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Timestamp

First Name

Last Name

Region

Email Address

Status

Hospital Covered

Hospital Category

PERMANENT
START

Hospital Level

PERMANENT
END

ROVING

Formal Economy

Informal Economy Lifetime Members

Indigents (NHTSPR)

Sponsored
Member

# of Client's served
No. of
during ward
member/dependent
classes, mother's
No. of Nonwho are able to
class, opd
PhilHealth
No. of PhilHealth
avail of the
lectures,etc.
member/dependent member/dependent
benefits

Non-Member

Hospital's Best
Practices

Membership

Contribution

ACAs

Healthcare
Provider Relations

Benefits

No Balance Billing

On site Point of
Care

All Case Rates


-inconsistent data
in IHCP portal. (In
iCARES and MDR
on hand of the
member, the
dependent was
reflected but in
IHCP portal
"undeclared
dependent" was
the remark.)

Internal

Email1 Template
Status[1]

-when payment
made in
Accredited
Collecting Agents
for IPM members
even though it was
updated, eligibility
to avail benefit is
always "NO".

4/3/2014 18:12:56 APRIL ANN

4/3/2014 21:05:36 GLADYS

MATUCAD

GODELOSON

NCR

NCR

hugoabrilmatucad@gmail.com
Permanent

gladluvsjesse@gmail.com
Permanent

4/3/2014 22:05:34 ERDEN JAN

LEGASPI

NCR

thepillareic06.
07@gmail.com

4/3/2014 22:46:35 GILBERT

MENDOZA

NCR

gil30.
mendoza@gmail.
com

4/4/2014 6:44:22 KATRINA

BELEN

NCR

UNIVERSITY OF
THE EAST
RAMON
MAGSAYSAY
MEDICAL
CENTER

PHILIPPINE
CHILDRENS
MEDICAL
CENTER

Permanent

EAST AVENUE
MEDICAL
CENTER

Permanent

VETERANS
MEMORIAL
MEDICAL
CENTER

katzycares@gmail.
com
Permanent

NOVALICHES
GENERAL
HOSPITAL

Private

Government

3/1/2014

3/1/2014

3/31/2014

3/31/2014

159

139

92

68

51

49

18

15

21

35

290

137

341

312

341

336

NONE

NONE

NONE

with good and


harmonious
relationship both to
the Healthcare
Provider and
Member/Patients. NONE

1.The ID of the
4p's member had a
discrepancy in her
surname. She
used his common
law husband's
name even they
were not yet
married.

1. PBEF and
iCARES were
sometimes not
consistent. The
dependent was
declared in
iCARES but in
PBEF it was not
eligible.
NBB Compliant
*Hospitalsponsored
members (HSMs)
enrolled this year
but with
succeeding
confinement in
another hospital
find it hard to avail
of benefits
because the BAS
wouldn't accept
HSM certificate
(only MDRs with
active validity
period).
Understandably,
MDRs can't be
printed yet as the
hospital-sponsor is
yet to pay the
premium
contribution to
PhilHealth.
Not fully compliant.

Government

3/1/2014

3/31/2014

363

238

25

113

137

48

1450

1286

1286

none

none

none

none

Government

3/1/2014

3/31/2014

64

34

19

10

577

123

123

None.

None.

None.

None.

113

They are still strict


on the
requirements of
the member like
for the formal
economy they still
want a certificate
of contribution as
an attachment
even though their
is a duly signed
CF1 from the
employer and
upon checking the
database their is a
contribution for the
members. Also in
informal economy
they still want to
have the
immediate quarter
in order to use
philhealth benefit
But as CARES we
still encouraged
them that if their is
qualifying
contribution they
may be able to use
their philhealth
benefits.

Private

3/1/2014

3/31/2014

39

89

10

15

258

113

-some member
complaining about
the small amount
of package for
procedure case
rate and when
NBB COMPLIANT patient expired.
NONE
NONE
1. Most members
that were enrolled
under Point of
Care was
readmitted in
another hospital
but the problem
was that, the
hospital couldnt
provide
them with
certification and
other requirements
because they
havent paid the
premium payment.

UCPB
SANGGANDAAN
NOVALICHES
QUEZON CITY is
accepting monthly
payment for
individual paying
member.
Bayad Center
located at Mabini
St. Brgy Sta. Lucia
Novaliches Q.C is
collecting a
processing fee of 8
pesos per filling up
form of quarter
payment by the
member.

PBEF is currently
used only for
viewing
member/patient's
eligibility, not as a
replacement for
MDR. Hospital is
still trying to figure
out how to
*Gunshot wound
Expenses for labs, integrate issuance
not surgically
diagnostic tests
of PBEF to the
managed is not
not available in the process flow of
compensable.
hospital are being availing of
*Neurocysticercosis paid by the
PhilHealth
not compensable. member.
benefits.
-I am encountering
inquiries both from
civilian and
veteran patients
regarding
reimbursement of
drugs and
medicines bought
outside the
hospital. The
hospital
reimburses their
receipts once they
are paid by
PhilHealth. For
civilian members,
the refund
depends on the
remaining amount
of benefit not yet
consumed and on
official receipts
submitted. For
members who are
also veterans, the
hospital
reimburses them
based on the
amount of
PhilHealth benefit
and their receipts. -No Balance Billing
policy is being
-Some members
implemented in
are asking for
VMMC. Identified
refund of
NBB Patients are
chemotherapy
not asked to
drugs. The hospital purchase drugs
reimburses them
and medicines as
after receiving
long as they are
payment from
classified
PhilHealth but only immediately upon
up to remaining
admission. They
amount not
are also not
consumed. I
charged beyond
informed them of the packaged
the PhilHealth
rates. Some
benefit for
patients are not
chemotherapy
identified as NBB
administration
patient upon
under the All Case admission. As a
Rates payment
result, they have
scheme. I
out-of-pocket
explained that they expenses. The
may not be able to hospital
reimburse the full reimburses their
amount of the
receipts upon
chemotherapy
discharge of the
drugs.
patient.
None.

2.Some POC
enrolled members
had discrepancies
with their profile
such as name and
birthdate when
they were enrolled.
I verified to
membership
section that birth
certificate was
enough as long as
the name in the
social service'
certificate that was
attached in claims
was correct.

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2.

*I STRONGLY
suggest
deployment of
another CARES to
East Avenue
Medical Center
due to the large
volume of clients
that we cater here.
*ICD-10 training.

Some class C3
and D
patients/members
are enrolled only to
POC on the day
the patient is due
for discharge,
hence defeating its
very purpose to
uphold NBB.

*Validity period of
land-based OFWs
be viewed in iCARES.
*Just wondering if
we will be given
corporate uniforms
(the white and
green polo shirttype usually worn
on Fridays), too?

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Not applicable.
The HCI portal is
not fully utilize by
the hospital
because there is
only one
installation of HCI
portal where
located at the
Optha Department
and is being used
for entry of the
cataract preauthorization letter
for approval. They
are only open from
8 to 5 every
monday to
saturdays at optha
department. They
may not able to
check whether the
member can use
or not their
philhealth benefit
upon confinement
of the members.
They are still
hesitant to use the
PBEF. They have
submitted a
request letter
already for
another installation
of the portal.

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Timestamp

First Name

4/4/2014 17:07:27 MONICA FE

Last Name

GALINATO

Region

NCR

Email Address

Status

fdgalinato@gmail.
com
Permanent

Hospital Covered

STA. TERESITA
GENERAL
HOSPITAL

Hospital Category

Private

PERMANENT
START

Hospital Level

3/1/2014

PERMANENT
END

3/31/2014

ROVING

Formal Economy

80

Informal Economy Lifetime Members

60

21

Indigents (NHTSPR)

Sponsored
Member

# of Client's served
No. of
during ward
member/dependent
classes, mother's
No. of Nonwho are able to
class, opd
PhilHealth
No. of PhilHealth
avail of the
lectures,etc.
member/dependent member/dependent
benefits

Non-Member

31

58

126

Hospital's Best
Practices

Having a ward to
ward visit to
encourage the
patients to use
their Philhealth
benefit and assist
them in their
requirements &
entertain their
questions about
142 Philhealth.

4/4/2014 20:22:19 JOSE DANTE

FERNANDO

NCR

kaeru102186@gmail.com
Permanent

BERNARDINO
GENERAL
HOSPITAL

Private

2/1/2014

2/28/2014

125

89

17

16

120

433

4/4/2014 21:53:11 Honey Ann

BALTAZAR

NCR

honeyapb@gmail.
com
Permanent

WORLD CITI
MEDICAL
CENTER

Private

3/1/2014

3/31/2014

114

17

101

315

They let members


who were admitted
and discharged
during the
weekends have
hospital
reimbursements.
(mostly for
employed
members who're
unable to complete
the required
documents;
unavailability of the
signatories during
424 the weekends)
Reminds patients
to accomplish
PhilHealth
requirements
before discharge.,
Provides a list of
requirements
attached to CF1
315 upon admission.

ALL
DEPARTMENT
OF THIS
INSTITUTION
HAS A SYSTEM
CALLED THE
SOURCE WHERE
IN EACH HEALTH
CARE PROVIDER
OR HOSPITAL
STAFF CAN
ACCESS
ANNEXES OF ALL
CASE RATES
AND PROVIDE
BASIC
INFORMATION
1563 ABOUT IT.

4/4/2014 21:54:06 Daryl

De Leon

NCR

dgdeleon19@gmail.com
Permanent

ST. LUKE'S
MEDICAL
CENTER - QC

Private

3/1/2014

3/31/2014

136

94

41

50

929

1563

4/4/2014 22:45:56 MARIA PAZ

GOMEZ

NCR

margo.
maio@gmail.com

PACIFIC GLOBAL
MEDICAL
CENTER
Private

3/1/2014

3/31/2014

126

75

27

21

115

Permanent

The hospital
provides training
about Philhealth
benefits and
requirements to
110 their employees.

Membership

NO FURTHER
ISSUES AND
CONCERN.

Contribution

NO FURTHER
ISSUES AND
CONCERN.

ACAs
PNB FELIX
AVENUE
BRANCHAPPLICABLE
PERIOD PAID IS
INCORRECT IN
THE O.R.
AMOUNT OF
1,800 FOR 072012 UP TO 062013 THAT MUST
BE 07-2012 UP
TO 12-2013
BECAUSE THE
CLIENT HAD AN
ADVANCE
PAYMENT TO
AVAIL THE
DISCOUNT FOR
2013.

Healthcare
Provider Relations

Benefits

PBEF WAS
IMPLEMENTED IN
THOSE PATIENT
WHO DOESN'T
HAVE A
REQUIREMENTS
ON HAND TO
AVAIL THE
BENEFIT OF
PHILHEALTH AT
HOSPITAL.

A member who
has no qualified
contribution wants
to be added as her
spouse's
dependent; it was
a saturday and she
is about to be
discharged.
LHIOs are not
open on
weekends.
- Team Leader
notified; instructed
the member to
attach a
deactivation letter
together with an
accomplished
PMRF to the claim. n/a

n/a

NO FURTHER
ISSUES AND
CONCERN.
noted problems
with regards to
PBEF. (hospital
clerks usually ask
for help with
regards with the
IHCP portal)
*A hole in the
PBEFs where
another member
could utilize your
membership just
by providing them
the systemgenerated required
attachments.
*You could use
your membership
for a parent whose
a non-senior
citizen in the
PBEF; the system
would just ask for
an accomplished
PMRF.

none

none

Does not state PF


deductions in
SOA.
none

none

CONCERNS
ABOUT ON HOW
TO ADD
DEPENDENTS
AND HOW TO
SHIFT FROM
FORMAL
ECONOMY TO
INFORMAL
ECONOMY.

SOME MEMBERS
STILL COMPLAIN
ABOUT THE RISE
OF THE
PREMIUM
PAYMENT. I JUST
ADVISED
MEMBERS THAT
IT WAS AN
ADJUSTMENT
MEMBERS WHO RATHER THAN
ARE INACTIVE
AN INCREASED.
FOR A COUPLE
TO PROVIDE
OF YEARS AND
MORE QUALITY
WANTS TO
CARE WHEN
No further issue/s
CONTINUE THEIR AVAILING
and concern
MEMBERSHIP.
PHILHEALTH.
encountered.

NONE

No Balance Billing

All Case Rates

NOT APPLICABLE
TO THE
HOSPITAL
BECAUSE IT IS A
PRIVATE
HOSPITAL. NBB NO FURTHER
IS NOT
ISSUES AND
IMPLEMENTED. CONCERN.

A member
complained with
regards to the
approval of her
cataract preauthorization; it
has been a month
since the hospital
applied for the
authorization but
the status was still
"pending".
- Notified my Team
Leader and the
BAS with the
issue.
Authorization was
then approved.
n/a

none

n/a

On site Point of
Care

NOT
APPLICABLE.

n/a

none
none
1.THE HCI
ENCOUNTERED
PROBLEM WHEN
IT COMES TO
CONTRIBUTIONS
OF A MEMBER, IT
WILL GIVE A "NO"
FOR ELIGIBILTY
EVEN IF IN ICARES AND
ACCOUNTING
REFLECTS THAT
THE MEMBER
HAS AN
UPDATED
PAYMENT OF
PREMIUMS.

2. DEPENDENTS
THAT ARE
DECLARED IN
THE MDR ALSO
GIVES A "NO"
FOR ELIGIBILITY.
SPECIFICALLY
DEPENDENTS
THAT HAS
DISABILITY,
PBEF WILL GIVE
AS CARES I CAN
AN
PROVIDE QUICK
INFORMATION
INFORMATION
THAT SAYS:
OF WHAT CAN
CANNOT BE
MEMBER AVAIL
DECLARED
WHEN USING
ABOVE 20 YRS.
PHILHEALTH
NOT APPLICABLE OLD.
NONE
The deployment of
Enhanced Health
Care Institution
started last March
12, 2014. The
portal can be used
to checked the
eligibility of the
patient upon
admission. The
PBEF provides
information as to
eligibility of the
patient to avail of
the benefit based
on the following
parameters:
Philhealth
membership or
dependency,
premium
contribution and
compliance to forty
five (45) days
benefit limit. But
the PBEF does not
provide any
information if the
medical cases or
the procedure is
covered by SPC.
The PBEF can
also replace the
MDR.ded
requirements (e.g.
MDR, properly
accomplished
CF1, properly
accomplished
PMRF) in case we
encounter any
discrepancies in
PBEF. The
hospitals were ho
However, we
observed some
discrepancies in
PBEF, like no
answer (YES or
NO) if the patient
is eligible to avail
Philhealth benefits
and not declared
as dependent in
PBEF but declared
as dependent in
MDR. We already
informed the BAS
regarding these,
and they told us to
attach the neeping
that the the
Corporation will
continue to
enhance the portal
so we can further
help the members
in complying the
requirements
needed.

Internal

NO FURTHER
ISSUES AND
CONCERN.
noted problems
with regards to
PBEF. (hospital
clerks usually ask
for help with
regards with the
IHCP portal)
*A hole in the
PBEFs where
another member
could utilize your
membership just
by providing them
the systemgenerated required
attachments.
*You could use
your membership
for a parent whose
a non-senior
citizen in the
PBEF; the system
would just ask for
an accomplished
PMRF.

none

Email1 Template
Status[1]

Email1 Template
sent to
fdgalinato@gmail.
com on 04/04/14
at 6:58:45 PM

Email1 Template
sent to
kaeru102186@gmail.com
on 04/04/14 at 9:
17:50 PM

Email1 Template
sent to
honeyapb@gmail.
com on 04/04/14
at 9:53:21 PM

Email1 Template
sent to
EMAIL UPDATES dgdeleon19@gmail.com
FROM PMT
on 04/04/14 at 9:
CARES.
54:14 PM

Email1 Template
sent to margo.
maio@gmail.com
on 04/04/14 at 10:
46:04 PM

Timestamp

First Name

FLORA JEAN
4/5/2014 0:08:59 TRACY

Last Name

AROMIN

Region

NCR

Email Address

Status

fjtracyaromin@gmail.com
Permanent

Hospital Covered

Hospital Category

COMMONWEALTH
HOSPITAL AND
MEDICAL
CENTER
Private

PERMANENT
START

Hospital Level

3/1/2014

PERMANENT
END

3/31/2014

ROVING

Formal Economy

148

Informal Economy Lifetime Members

139

23

Indigents (NHTSPR)

Sponsored
Member

# of Client's served
No. of
during ward
member/dependent
classes, mother's
No. of Nonwho are able to
class, opd
PhilHealth
No. of PhilHealth
avail of the
lectures,etc.
member/dependent member/dependent
benefits

Non-Member

19

78

569

Hospital's Best
Practices

Membership
startek company
and teletech (call
center company)
were signing the
part 4 of CF1 even
for the none
eligible employees
who were below 3
CHMC gives
months hired. we
consideration for
have 3 cases for
members who
the month of
were admitted
march.
during weekends -to make sure for
and holidays.
the other
Members will sign members,we
an "undertaking
requested a
form" with the
certificate of
deadline on when contribution to
will they going to
make sure that the
complete/pass
member is eligible
their eligibility
to use their
requirements.
philhealth. if they
They will instantly cannot provide a
reimburse the
contribution,we
philhealth benefits thoroughly
to the members
interview the
once they
member and check
accomplish the
their contribution in
587 requirements.
system.

Contribution

ACAs

Healthcare
Provider Relations

Benefits

No Balance Billing

*seaman members
who were not
informed on how to
continue their
philhealth
contributions after
their contract as
onboard member.
-i instructed them
to change their
category as self
earning member
and pay their
contributions until
they will have the
next contract as
seaman.

none

none

none

none

All Case Rates

On site Point of
Care

PBEF printing was


implemented.
some of the
confusion for the
choices of
attachments (if the
system says "NO")
needs more
enhancement for
the final format;
NAME OF THE
COMPANY(for
employed
members);
COVERAGE (for
OFW and
SPONSORED);
none

Internal

none

Email1 Template
Status[1]

Email1 Template
sent to
fjtracyaromin@gmail.com
on 04/05/14 at 12:
09:07 AM

Timestamp

First Name

MA. CHRISTINA
4/5/2014 0:51:29 LOUISE

Last Name

DUNCANO

Region

NCR

Email Address

Status

xtina.
duncano07@gmail.com
Permanent

Hospital Covered

PHILIPPINE
HEART CENTER

Hospital Category

Government

PERMANENT
START

Hospital Level

3/1/2014

PERMANENT
END

3/31/2014

ROVING

Formal Economy

154

Informal Economy Lifetime Members

230

94

Indigents (NHTSPR)

Sponsored
Member

# of Client's served
No. of
during ward
member/dependent
classes, mother's
No. of Nonwho are able to
class, opd
PhilHealth
No. of PhilHealth
avail of the
lectures,etc.
member/dependent member/dependent
benefits

Non-Member

15

25

380

4377

3116

Hospital's Best
Practices

Membership

a client who claim


that his spouse is
a private
employee, but
when i checked
thru the ICARES, it
has an open
category. I tried to
verify thru PBEF
and the eligibility
status is un N/A,
so I informed the
relative to submit
PMRF and ER2 to
the nearest lhio for
them to avail the
benefit, but as
internal agreement expected the
with
relative was upset
members/relative and told me " may
to submit
masasaktan" and
requirements even asking me who to
after discharge for blame. I told the
them to still avail
member to veriy
philhealth, for
from the employer
some valid
but for the
reasons of
meantime he
members for not
needs to go to the
complying
nearest lhio and
documentary
update the cater of
requirements on
his wife to avail
873 time.
outright deduction. n/a

Contribution

ACAs

PAR with no
applicable period
paid by the
numbers, only
showing date
payment, amount,
transaction
number. It is
difficult to verify
since payments
are not yet posted
at treasury. ( sm )

Healthcare
Provider Relations

reminding some of
the billing clerk
every now and
then regarding the
extension of use of
the old CF1 until
march 31, 2014
and 3/6 eligibility
requirement for
IPP members.
n/a

Benefits

No Balance Billing

still not
implemented.

All Case Rates

members
complaining about
SPC ruling and as
per most of the
members all case
rate package is
way smaller than
the previous FFS
computation (
angiogram hops
bill dedcition for
only 5500 vs. ffs
case a; cad only
worth 2800
deduction for act;
bypass operation
only aroung
21,000 vs ffs case
c., etc.)

On site Point of
Care

still not
implemented, with
same reason from
the social service
that the IT
department of
philhealth did not
give any
instruction on how
to use the system,
still can not access
the system.

Email1 Template
Internal
Status[1]
I always receive
calls from different
regions asking for
assistance for their
"VIPS" or inquiries
with out even
informing my TL or
direct supervisor
for the to verify or
screen
informations.
One particular
incident happened
last wednesday
march 26, 2014
around 2:50pm, I
received a ams
and call from Mr.
marvin ( PRO 8
TL; 09157613435)
asking me to
check a certain
patient Dr.
Usafeno Obial for
me to confirm if the
patient is admitted
at PHC and
requesting me to
assist the said
patient. I
immediately
checked the billing
section's admitting
list and there it
reflected that the
patient was
admitted march
23, 2014, I tried to
call patient's room
several times to
ask the
patient/relative for
any philhealth
assistance, but
nobody answered
my call, I then
called the patient's
nurse station to
request the relative
if they could go to
my post since I
cannot go room to
room since I have
clients every now
and then. MR.
marvin again
called me for
follow up and
asked me if I could
make an
exemption and go
personally to the
patient's room
since he is a
former HCDMD
head as claimed. I
went to Dr. Obial's
room at room
357A brought CF1,
cf2 and pmrf
incase he needs
some eligibility
requirements
update, but Dr.
Obial immediately
told me that he is
scheduled for
BYPAS surgery on
March 29, and he
too me that he was
informed by the
surgery
department that
there is a process
flow for the z ben
availment which I
confirmed that as
per PHC's process
flow to will take 23weeks for the pre
authorization and
needs to be preapproved prior to
the scheduled
surgery. He told
me he wants to
ask my assistance
" to fast track" the
said process he
also informed me
that he already
informed RVP
Bacareza. I told
Dr. OBial that I
need to verify from
my TL and direct
supervisor Sir Rey
Sulit about his
request. I called up
my TL about Dr.
Obials request and
was informed that
she will verify with
BAS for the
process and will
update me first
thing in the
morning. When I
got back to my
post, PMT also
called up asking
me to assist the
same patient, I
informed the PMT
that I already
informed my TL
and needs to verify
from BAS re
patient's request. I
again received
another call from
mr. marvin asking
for any update and
ask me about the
process flow for z
ben preauthorisation. Past
5pm my TL called
up asking me if I
informed the said
patient that he
CANNOT avail the
Zben since it
needs 2-3weeks
process for the
pre- auth, which
was not the real
story since I only
informed the
member about the
process flow and
told him I will
inform my TL
about it since it is
beyond my
jurisdiction. The
ned day post I
received a txt from
Mr. Emmanuel (
09173250906; as
per txt special
office in RVP
Bacareza) asking if
we can assure and
facilitate the z ben
claim of the patient
and if they need to
"TAP" the officers
and help Dr. Obial
since he is a
former HCMD
head. The plan
was to bring the
pre-auth papers
personally if
completed with in
the day as per
instruction of my
TL but
unfortunately since
he has not yet
submitted any LAB
results ME form
and complete pre- Email1 Template
sent to xtina.
auth check list it
was not brought to duncano07@gmail.com
on 04/05/14 at 12:
BAS the same
day. I informed the 51:40 AM
attending
physician and the
z ben coordinator
about it and DR.
Fajardo (
cardiologist) is
willing to complete
the pre-auth but he
needs to cheek
some lab results
and test (2d echo)
which is scheduled

Timestamp

First Name

MA. CHRISTINA
4/5/2014 0:51:29 LOUISE

Last Name

DUNCANO

Region

NCR

Email Address

Status

xtina.
duncano07@gmail.com
Permanent

Hospital Covered

PHILIPPINE
HEART CENTER

Hospital Category

Government

PERMANENT
START

Hospital Level

3/1/2014

PERMANENT
END

3/31/2014

ROVING

Formal Economy

154

Informal Economy Lifetime Members

230

94

Indigents (NHTSPR)

Sponsored
Member

# of Client's served
No. of
during ward
member/dependent
classes, mother's
No. of Nonwho are able to
class, opd
PhilHealth
No. of PhilHealth
avail of the
lectures,etc.
member/dependent member/dependent
benefits

Non-Member

15

25

380

4377

3116

Hospital's Best
Practices

Membership

Contribution

a client who claim


that his spouse is
a private
employee, but
when i checked
thru the ICARES, it
has an open
category. I tried to
verify thru PBEF
and the eligibility
status is un N/A,
so I informed the
relative to submit
PMRF and ER2 to
the nearest lhio for
them to avail the
benefit, but as
internal agreement expected the
with
relative was upset
members/relative and told me " may
to submit
masasaktan" and
requirements even asking me who to
after discharge for blame. I told the
them to still avail
member to veriy
philhealth, for
from the employer
some valid
but for the
reasons of
meantime he
members for not
needs to go to the
complying
nearest lhio and
documentary
update the cater of
requirements on
his wife to avail
873 time.
outright deduction. n/a

4/5/2014 6:10:35 Aliza Teresa

Armea

NCR

alizaarmea20@gmail.com
Permanent

FAR EASTERN
UNIVERSITYNRMF

Private

3/1/2014

3/31/2014

44

60

15

15

542

673

strict compliance
with the
561 requirements

4/5/2014 9:18:42 ALYSSA MAE

TANDOC

NCR

a.m.j.
tandoc024@gmail.
com
Permanent

ANGONO
MEDICS
HOSPITAL

Private

3/1/2014

3/31/2014

100

39

179

374

361

4/5/2014 9:19:17 ALYSSA MAE

TANDOC

NCR

a.m.j.
tandoc024@gmail.
com
Permanent

ANGONO
MEDICS
HOSPITAL

Private

3/1/2014

3/31/2014

100

39

179

374

361

There is an
increase in
membership

ACAs

PAR with no
applicable period
paid by the
numbers, only
showing date
payment, amount,
transaction
number. It is
difficult to verify
since payments
are not yet posted
at treasury. ( sm )

Members and
dependents were
able to comply with mostly i
their
encountered
monthly/quarterly/annual
bayad center or
contributions
sm malls...

Healthcare
Provider Relations

Benefits

reminding some of
the billing clerk
every now and
then regarding the
extension of use of
the old CF1 until
march 31, 2014
and 3/6 eligibility
requirement for
IPP members.
n/a

none

some are still


complaining
regarding minimal
benefits

No Balance Billing

still not
implemented.

none

All Case Rates

members
complaining about
SPC ruling and as
per most of the
members all case
rate package is
way smaller than
the previous FFS
computation (
angiogram hops
bill dedcition for
only 5500 vs. ffs
case a; cad only
worth 2800
deduction for act;
bypass operation
only aroung
21,000 vs ffs case
c., etc.)
they were able to
adjust with the new
ACR and they
were glad that
ACR 3 were
already been
released

On site Point of
Care

former HCMD
head. The plan
was to bring the
pre-auth papers
personally if
completed with in
the day as per
instruction of my
TL but
unfortunately since
he has not yet
submitted any LAB
results ME form
and complete preauth check list it
was not brought to
Email1 Template
BAS the same
day. I Internal
informed the Status[1]
attending
physician and the
z ben coordinator
about it and DR.
Fajardo (
cardiologist) is
willing to complete
the pre-auth but he
needs to cheek
some lab results
and test (2d echo)
which is scheduled
friday morning.
The coordinator
also told me that if
the patient wish to
claim for the z ben
package he needs
to re schedule the
surgery for them to
present the patient
to the expert panel
for medical
evaluation which is
only scheduled
every wednesday.
Patient is not
willing to re shed
the surgery and his
plan is to push
through on
saturday, present
him on wednesday
for evaluation and
if nor approved he
will file for
reimbursement, I
informed Sir Rey
Sulit and my TL
about it and ask
my to try to finish
the said pre auth.
Unfortunately it
was not completed
last friday since
the surgeon and
the expert panel is
not around and Sir
Rey instructed me
to inform patient
that the only way
for him to avail the
z ben is to move
the schedule for
the proper process
of pre-auth as per
instruction from
BAS and branch
manager. I
explained
everything to the
patient and he
agreed that he will
no longer file for
the z ben since it is
stressful for him to
move and wait for
the pre-auth
process and can
only avail the ACR
package.

still not
implemented, with
same reason from
the social service
that the IT
department of
philhealth did not
give any
instruction on how
to use the system,
still can not access
the system.

For me if there is
any VIP clients
from internal office
it should first ask
assistance from
the supervisor or
the TL since we
cares has no
means on verifying
the said
information give. It
is difficult on our
part on giving
assistance on
complicated
Email1 Template
situations like this sent to xtina.
especially if we
duncano07@gmail.com
know the rules and on 04/05/14 at 12:
the policies.
51:40 AM

none

We were able to
help[ at the same
time learn from
them

Email1 Template
sent to
alizaarmea20@gmail.com
on 04/05/14 at 6:
10:43 AM
Email1 Template
sent to a.m.j.
tandoc024@gmail.
com on 04/05/14
at 9:18:56 AM
Email1 Template
sent to a.m.j.
tandoc024@gmail.
com on 04/05/14
at 11:23:42 AM

Timestamp

First Name

CHRISTIAN
4/5/2014 11:23:33 ALDRIN

Last Name

MABERIT

Region

NCR

Email Address

Status

christianaldrinmaberit@gmail.com
Permanent

Hospital Covered

PHILIPPINE
CHILDREN'S
HOSPITAL

Hospital Category

PERMANENT
START

Hospital Level

PERMANENT
END

ROVING

Formal Economy

Informal Economy Lifetime Members

Indigents (NHTSPR)

Sponsored
Member

# of Client's served
No. of
during ward
member/dependent
classes, mother's
No. of Nonwho are able to
class, opd
PhilHealth
No. of PhilHealth
avail of the
lectures,etc.
member/dependent member/dependent
benefits

Non-Member

Hospital's Best
Practices
696 - Total number
of discharges
309 - Total number
of discharges with
patients able to
avail of PhilHealth
CARES ROUTINE
WORK PROCESS
IN NCH
All patients with
PhilHealth
concerns head
directly or
instructed to go to
the admitting
section where the
CARES is
stationed. All of
their queries and
problems are
attended to.
Documentary
requirements
together with the
way the hospital
processes claims
are explained to
them upon
admission. The
hospital is strict
when it comes to
documentary
requirements.
These are all listed
to them. They are
advised to
complete these
papers the earliest
time possible
because the
hospital will only
start charging their
expenses to
PhilHealth once
these documents
are completed,
seen by CARES
and submitted to
the billing section.
The CARES signs
the completed
documents on the
right upper hand
corner of the CF1
to remark that
these papers are
seen and verified
in the system,
checked for its
completeness and
went through the
CARES scrutiny
before it is passed
to the billing office.
I made it clear to
the hospital that
my signature is not
a mark certifying
that the claims are
sure for
reimbursement. It
is only to signify
that they are
checked and
completed as
required by
hospital. Only
completed papers
are signed and
accepted by the
billing. These are
properly
accomplished
CF1, proof of
contribution,
updated MDR with
dependents
already declared
and a photocopy of
philhealth or any
valid id.
It is mentioned that
medical needs are
purchased when
requirements are
not completed.
Oftentimes,
members with
incomplete papers
are handed
prescriptions and
lab requests for
payment but due
to financial
constraints they
are unable to
release money at
once. To relieve
them of expenses
they seek approval
to deduct it to
PhilHealth benefit
package despite
having incomplete
papers. Thats
when I assist them
in requesting the
billing to grant their
request provided
that I verified their
eligibility in the
iCares and a
prescribed time for
completion is
assured. The
billing head most
of the time
approves this kind
of transactions so
long as it has the
backing of
CARES. Medicines
and labs are not
charged to them
thereafter and until
package rate is
consumed.
Indigent patients
are no longer
charged with
anything in
compliance to NBB
policy.
It is always a case
that some hospital
policies make it
difficult for
members to use
their benefits.
When faced with
conflicting and
difficult cases, I
always raise it to
the billing section
of the hospital.
With a proper
explanation
supported with
written issuances
from PhilHealth, an
agreement is
reached to the
benefit of the
member. Only a
cordial and goodintentioned
discussion about a
problem is needed
to achieve
harmony and
arrive at a solution.
All are done for the
benefit of their
patients and our
members. It is
assured that the
hospital process
does not hamper
much less prevent
the member to
enjoy their benefits
and all possible
options are
exhausted for their
sake.

Government

3/1/2014

3/31/2014

173

59

91

25

10

696

309

BEST
309 PRACTICES
CARES
1.Press the
patients to submit
PhilHealth
documents
immediately or as
early as possible
so as not to shell
out money in
obtaining
medicines or for
laboratory

Membership

Contribution

ACAs

Healthcare
Provider Relations

Benefits

No Balance Billing

All Case Rates

On site Point of
Care

Internal

Email1 Template
Status[1]

Advisories and
Information
Advisory or
publication of any
kind from
PhilHealth must be
anticipated and be
conveyed to us
prior to its release
and before it
reached the public.
Sometimes
members are the
bearers of new
information and we
are the recipients.
Please keep us
posted from time
to time. However,
we will not be
remiss in keeping
ourselves informed
at all times.
Consider
furnishing us with
copies and lists of
office orders
issued by the
PhilHealth if it is
permitted. Office
Orders sometimes
stipulate orders
with distinct clarity
and
comprehensiveness
compared to
circulars which we
have an easy
access to.

Unnecessary
documents
required by the
hospital
-I have been
persistent in
convincing the
hospital that
several of the
papers and
documents they
require are not
necessary and
may not affect their
claims in their
absence. Leniency
in this policy may
provide the
members
convenience when
it comes to
securing, say, a
valid ID or free
them from the cost
of photocopying.

I encountered a
member whose
patient, a 9-year
old minor
possesses a valid
philHealth
membership. I
discovered that the
other of his
children with ages
below the former
are also active
sponsored
members for 2014.
The father also
admits that all of
his children are
4ps member.
Since the child is a
member I advised
him to use his own
PhilHealth and
have the father
sign the forms on
his behalf because
he is a minor.
For the purpose of
verification, if such
can be done, the
following
PhilHealth
numbers of the
said members are
listed:
022000915800
022001250268
022001249596
none

none

Maintaining a good
staff relationship
with the hospital
personnel
especially among
people whom the
CARES has direct
contact with. The
hospital is warm in
their welcome and
is actively working
in collaboration
with the CARES to
effectively deliver
services to their
patients
particularly when it
comes to
PhilHealth
concerns of their
patients.
Sometimes
differences in
policy
understanding
prompt us to
engage in a
discussion and/or
sometimes dispute
that are most of
the time
manageable.

Professional Fees
Patients admitted
to pay ward of the
hospital are
charged with
professional fees
and are paid
separately from
the hospital bill.
There are in
several instances
relatives
complaining about
the payment
charged by their
doctors. They
frequently ask the
billing section
about the
mechanism in
which to pay and
deduct their
PhilHealth benefits
from the PF but
the Billing section
is in constant
refusal to meddle
or even comment
on how their
doctors charge
their PFs. Billing
slips from doctors
reflect the amount,
discounts and the
net PF. For
patients with
PhilHealth, a note
of net of
PhilHealth is
written alongside
the PF amount
indicating that the
deductions are
already made. But
the exact amount
deducted is not
specified or is not
as exactly as the
case rate amount.
Only the remaining
amount to be paid
is reflected in the
statement and not
the actual PF from
which the
deductions are
made. After
payments are
made by the
patient, doctors will
still receive the
30% amount
computed from the
case rate paid by
PhilHealth. It
appears, in my
observation and
also to the billing
staffs that the 30%
serves as an addon to the doctors
pay. You do not
question the
doctors way of
charging their PFs
they say. But I
nevertheless
continue to inform
the patients of their
benefits to the
most exact amount
so that they
themselves can
question their
doctors PF
charges.
OTHERS:
-Hospital is strict
with the
documents they
require from the
patient
-Some doctors
seemingly
excessive charges
and inaccurate
PhilHealth
deductions
-All other problems
and observations I
reported in my
previous ARs are
still in existence in
the hospital.

Guidelines for
CARES
Draft guidelines
for CARES
allowing them to
participate in round
table discussions
or meetings
involving their
hospital of duty
and PhilHealth. It
will also make the
sense of
collaboration more
palpable if CARES
are given
clearance to attend
conferences with
hospital staffs to
receive
instructions or
lectures on the
introduction of new
PhilHealth scheme
and programs.
NBB
The hospital
strictly implements
the NBB policy of
PhilHealth. Upon
the introduction of
the All Case Rate
and the increasing
number of Indigent
and Sponsored
members also
comes the
increase in the
number of patients
qualified for NBB.
The hospital
instituted
measures and
policy on how to
effectively
implement and
provide to the
member the
benefits of NBB.
Qualified patients
are not made to
pay for their
hospitalization.
There are however
instances where
patients shell out
money for
medicines and
examinations not
available in the
hospital. Another
reason members
are paying out-ofpocket for lab
exams and
medicines is when
they are not yet
recognized or
tagged as NBB
patients. It is upon
admission or until
the member
submits all their
PhilHealth
requirements. It is
imperative that
members complete
these documents
before they can
avail of their no
balance billing
benefits. All
expenses incurred
for such purposes
may be refunded
after payment is
made by
PhilHealth to the
hospital. The
refund will be
made to all valid
receipts even if the
sum exceeds
beyond the case
rate amount. This
is at least the
process as they
are conveyed to
me by the Billing
section.

Access and
Trainings

PBEF
The hospital has
just had the IHCP
portal reinstalled
after losing it to
reformatting
months earlier. I
discussed to them
the use of the new
system that
generates PBEF.
The hospital is
new to the
application but is
starting to gauge
their employees to
its operation and
purpose. We have
tried several set of
claims using the
system but the
hospital is
adamant to totally
shift from manual
collection of
documents to
automatedpaperless
transactions. I
insisted they start
to use the system
to all claims to
provide ease to the
members and to
them also in terms
of processing.
To make the
hospital fully adopt
the use of the new
system,
introducing it
gradually is vital
and small changes
in hospitals billing
process are
needed in order to
gain compliance to
new method of
document
collection. It is also
important that the
CARES assist the
hospital in trusting
the System and
process of
automation in
general.

Grant CARES
an unfettered
access to
PhilHealth
database and
circulating orders
among offices
particularly if they
relate to the
activities that
concern our work
and the members.
Provide CARES
with trainings and
seminars deemed
important to
properly equip us
with knowledge
and understanding
of social insurance
and public service.
Examples include
SHINES, ICD,
ARTA to say
some.

Others
Constant supply
of flyers, leaflets
and forms for
distribution. Also,
please
continue/start the
distribution of
printed copies of
circulars and
advisories. Printed
copies are
convenient reading
materials and are
in form ready for
easy reproduction.
This is helpful
especially if the
provision of these
materials to the
PhilHealth staff of
the hospital would
be necessary.
In addition to
prints, please
consider providing
us with basic office
The process of
materials that we
enrolling POC
patients continues frequently utilize.
in the hospital and Keep the line of
has already
Email1 Template
communication
sponsored s
sent to
significant number among CARES
christianaldrinmaberit@gmail.com
and supervisors
of indigent
on 04/05/14 at 11:
open and on time. 23:42 AM
patients.

Timestamp

First Name

Last Name

Region

Email Address

Status

Hospital Covered

Hospital Category

PERMANENT
START

Hospital Level

PERMANENT
END

ROVING

Formal Economy

Informal Economy Lifetime Members

Indigents (NHTSPR)

Sponsored
Member

arrive at a solution.
All are done for the
benefit of their
patients and our
members. It is
assured that the
hospital process
does not hamper
much less prevent
the member to
enjoy their benefits
and all possible
options are
# of Client's served
No. of
exhausted for their
during ward
member/dependent sake.
classes, mother's
No. of Nonwho are able to
class, opd
PhilHealth
No. of PhilHealth
avail of the
Hospital's Best
BEST
lectures,etc.
member/dependent member/dependent
benefits
Practices
PRACTICES
CARES
1.Press the
patients to submit
PhilHealth
documents
immediately or as
early as possible
so as not to shell
out money in
obtaining
medicines or for
laboratory
examinations that
the hospital
provides.
2.Provide clear
and concise
instructions to our
members to save
them from the
burden of repeat
errands when
accomplishing
their requirements.
3.Give the
members the
easiest and the
most convenient
way in solving the
conundrum
surrounding their
status as
PhilHealth
members.
4.Furnish the
hospital with
circulars and
orders from
PhilHealth to help
them with the
implementation of
their policies or if
possible to
supplant their
current policies
that are not in line
or inconsonant
with the actual
policy of the
Corporation.

Non-Member

HOSPITAL
1.NBB policy is
followed by the
hospital for
confinements
involving
sponsored and
indigent members
and their
dependents.
2.Patients who
have already
completed the
required PhilHealth
documents are
given the privilege
of not paying for
services the
hospital can
provide. The
amount of these
services like drugs
and medicines and
laboratory
examinations are
deducted from the
maximum
PhilHealth amount
per disease type
as identified by the
Billing staff upon
admission. If the
said amount is
consumed, only
then the patients
are made to pay
for remaining
hospital services.
Out of hospital
purchases are
common if medical
needs are not
available in the
facility. Receipts
from the said
purchases are
allowed for
attachment in the
claim.

CHRISTIAN
4/5/2014 11:23:33 ALDRIN

MABERIT

NCR

christianaldrinmaberit@gmail.com
Permanent

PHILIPPINE
CHILDREN'S
HOSPITAL

Government

3/1/2014

3/31/2014

173

59

91

25

10

696

309

309

Membership

Contribution

ACAs

I encountered a
member whose
patient, a 9-year
old minor
possesses a valid
philHealth
membership. I
discovered that the
other of his
children with ages
below the former
are also active
sponsored
members for 2014.
The father also
admits that all of
his children are
4ps member.
Since the child is a
member I advised
him to use his own
PhilHealth and
have the father
sign the forms on
his behalf because
he is a minor.
For the purpose of
verification, if such
can be done, the
following
PhilHealth
numbers of the
said members are
listed:
022000915800
022001250268
022001249596
none

none

Healthcare
Provider Relations

Maintaining a good
staff relationship
with the hospital
personnel
especially among
people whom the
CARES has direct
contact with. The
hospital is warm in
their welcome and
is actively working
in collaboration
with the CARES to
effectively deliver
services to their
patients
particularly when it
comes to
PhilHealth
concerns of their
patients.
Sometimes
differences in
policy
understanding
prompt us to
engage in a
discussion and/or
sometimes dispute
that are most of
the time
manageable.

several of the
papers and
documents they
require are not
necessary and
may not affect their
claims in their
absence. Leniency
in this policy may
provide the
members
convenience when
it comes to
securing, say, a
valid ID or free
them from the cost
of photocopying.
Benefits
Professional Fees
Patients admitted
to pay ward of the
hospital are
charged with
professional fees
and are paid
separately from
the hospital bill.
There are in
several instances
relatives
complaining about
the payment
charged by their
doctors. They
frequently ask the
billing section
about the
mechanism in
which to pay and
deduct their
PhilHealth benefits
from the PF but
the Billing section
is in constant
refusal to meddle
or even comment
on how their
doctors charge
their PFs. Billing
slips from doctors
reflect the amount,
discounts and the
net PF. For
patients with
PhilHealth, a note
of net of
PhilHealth is
written alongside
the PF amount
indicating that the
deductions are
already made. But
the exact amount
deducted is not
specified or is not
as exactly as the
case rate amount.
Only the remaining
amount to be paid
is reflected in the
statement and not
the actual PF from
which the
deductions are
made. After
payments are
made by the
patient, doctors will
still receive the
30% amount
computed from the
case rate paid by
PhilHealth. It
appears, in my
observation and
also to the billing
staffs that the 30%
serves as an addon to the doctors
pay. You do not
question the
doctors way of
charging their PFs
they say. But I
nevertheless
continue to inform
the patients of their
benefits to the
most exact amount
so that they
themselves can
question their
doctors PF
charges.
OTHERS:
-Hospital is strict
with the
documents they
require from the
patient
-Some doctors
seemingly
excessive charges
and inaccurate
PhilHealth
deductions
-All other problems
and observations I
reported in my
previous ARs are
still in existence in
the hospital.

No Balance Billing

All Case Rates

On site Point of
Care

furnishing us with
copies and lists of
office orders
issued by the
PhilHealth if it is
permitted. Office
Orders sometimes
stipulate orders
with distinct clarity
and
comprehensiveness
compared to
circulars which we
have an easy
Email1 Template
access
to.
Internal
Status[1]
Guidelines for
CARES
Draft guidelines
for CARES
allowing them to
participate in round
table discussions
or meetings
involving their
hospital of duty
and PhilHealth. It
will also make the
sense of
collaboration more
palpable if CARES
are given
clearance to attend
conferences with
hospital staffs to
receive
instructions or
lectures on the
introduction of new
PhilHealth scheme
and programs.

NBB
The hospital
strictly implements
the NBB policy of
PhilHealth. Upon
the introduction of
the All Case Rate
and the increasing
number of Indigent
and Sponsored
members also
comes the
increase in the
number of patients
qualified for NBB.
The hospital
instituted
measures and
policy on how to
effectively
implement and
provide to the
member the
benefits of NBB.
Qualified patients
are not made to
pay for their
hospitalization.
There are however
instances where
patients shell out
money for
medicines and
examinations not
available in the
hospital. Another
reason members
are paying out-ofpocket for lab
exams and
medicines is when
they are not yet
recognized or
tagged as NBB
patients. It is upon
admission or until
the member
submits all their
PhilHealth
requirements. It is
imperative that
members complete
these documents
before they can
avail of their no
balance billing
benefits. All
expenses incurred
for such purposes
may be refunded
after payment is
made by
PhilHealth to the
hospital. The
refund will be
made to all valid
receipts even if the
sum exceeds
beyond the case
rate amount. This
is at least the
process as they
are conveyed to
me by the Billing
section.

Access and
Trainings

PBEF
The hospital has
just had the IHCP
portal reinstalled
after losing it to
reformatting
months earlier. I
discussed to them
the use of the new
system that
generates PBEF.
The hospital is
new to the
application but is
starting to gauge
their employees to
its operation and
purpose. We have
tried several set of
claims using the
system but the
hospital is
adamant to totally
shift from manual
collection of
documents to
automatedpaperless
transactions. I
insisted they start
to use the system
to all claims to
provide ease to the
members and to
them also in terms
of processing.
To make the
hospital fully adopt
the use of the new
system,
introducing it
gradually is vital
and small changes
in hospitals billing
process are
needed in order to
gain compliance to
new method of
document
collection. It is also
important that the
CARES assist the
hospital in trusting
the System and
process of
automation in
general.

Grant CARES
an unfettered
access to
PhilHealth
database and
circulating orders
among offices
particularly if they
relate to the
activities that
concern our work
and the members.
Provide CARES
with trainings and
seminars deemed
important to
properly equip us
with knowledge
and understanding
of social insurance
and public service.
Examples include
SHINES, ICD,
ARTA to say
some.

Others
Constant supply
of flyers, leaflets
and forms for
distribution. Also,
please
continue/start the
distribution of
printed copies of
circulars and
advisories. Printed
copies are
convenient reading
materials and are
in form ready for
easy reproduction.
This is helpful
especially if the
provision of these
materials to the
PhilHealth staff of
the hospital would
be necessary.
In addition to
prints, please
consider providing
us with basic office
The process of
materials that we
enrolling POC
patients continues frequently utilize.
in the hospital and Keep the line of
has already
communication
sponsored s
significant number among CARES
and supervisors
of indigent
open and on time.
patients.

Email1 Template
sent to
christianaldrinmaberit@gmail.com
on 04/05/14 at 11:
23:42 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.