Pauneauraap.ore02 ©, PhilHealth Document Review and Approval Selmer sae Request Form Required Data for President's Report (September 30 - October 4, 2019) Document Title: Document Type: DD seanvat O Procedure work instruction EX others MEMO Revision No. Document Code: 2019-000 Originator/Proponent, _ ORVP-Planning Date of Request! _10-4-19 ReasonforRequest| ET new Revision Others (specty) Details frcude instructions, any) Required Data for President’s Report (Sept 0 = October 4, Relevant Documents (epecity documents that maybe affected by the revision) Retention Period of Superseded Document: nae ae aa as a Sees ACISCLO B. MILITANTE, JR stan fella DR. ROSARIO B. SUYOM. ae NS po)cela JOSEPHINE B. MOSQUISA wold [2014 J uedser) OIC Chief, MSD MIRAMAR P. ZABATA nm PRO / PAU fe 4 4 q Py ATTY. EMMANUEL A. RELADOR: ie Hay ak 10/4/2014 _A- by DateTime ‘Comments Wane & Office) oe fou Regional Vice President M 3S Compete StaFFWorKWORKSsame saNneR None eathines 053) 355 S503 es ‘worm shiealthov.oh @ Repubicaf the Philippines a PHILIPPINE HEALTH INSURANCE CORPORATION October 4, 2019 MEMORANDUM FOR : BGEN. AGUSTUS H. DE VILLA, Executive Vice President FROM PhilHealth Regional Office 8 SUBJECT : juired Data for Presi ort (Sey = 4.2019) In compliance with the Submission of Required Data for President's Report for September 30 — October 4, 2019, we are respectfully forwarding the following reports: I. Status of this week’s claims processing (September 30 — October 4, 2019). * Pending the availability of required reports in the PowerBI, PROS through its IT Management Section as extracted the required data from the Database Wareboxse (DBWH). IL Status of cases received in the past weeks. September 30— October 4, 2019) IIL, Initiatives undertaken to implement or facilitate the implementation of UHC Act and UHC Integration. For your information and guidance. @rrireathorci GO teach shestn @actoncenterantiheatnoovehA. Claims Paid Per Membership Category ANNEX A Status of Claims Processing vaneeracls Caeeee “Total Weekly Amount of [Total Weekly No] Percentage al k ims Paid of Claims Paid | Distribution [SPONSORED a(t 15,372,440 1,823] 25.62%] LIFETIME MEMBER 1,708,310] 219] 3.08% INDIGENT, 19541,812 2,197] 30.88% INIOR CITIZEN (RA 10645) 8,859,298] 970 13.63%] INFORMAL ECONOMY 8,780 B53 11,9994 FORMAL ECONOMY 9,955,856 7052 14.79% OTHERS, 10,000] 1 0.01% TOTAL, 1,476,496] 75 700.0084 B. Claims Paid Per Type of Facility — —+— yest mechiy Total Weekly Amount of |Total Weekly Percentage Claims Paid ofClaims Paid | Distribution [ANIMAL BITE PACKAGE PROVIDER era ronaer are 328000] zal 350% FREE STANDING DIALYSIS CLINIC 7,513,200] 416 5.85%] JINFIRMARY/DISPENSARY 3,248,966] 556| 7.81% LEVEL 1 HOSPITAL 35,089,206 3,606) 50.68% LEVEL 2 HOSPITAL 532,508] 7,043] 14.66% LEVEL 3 HOSPITAL 8,758 916| 647] 9.09% MCP PROVIDER 3,297,700] 469) 6.5974 [ES Dos PACKAGE PROVIDER 208,000 mat 1A 7Aa5 [TOTAL 61,476,496} 700.0096}C.Claims Paid For Top 15 ICD-10 Codes Saran "Teal sty Amounrat [Toalweuayo] Pacaag Cee ‘Claims Paid. of Claims Paid Distribution ri aE EQUIVALENT TO CAP, MODERATE RISK IN THE 82/500 = 18.92 REVENTION OF C 18.16%] 1N39.0 [SPECIFIED ae aL 13.95% }A97.0 FEVER WITHOUT WARNING SIGNS: 9.04%) 45.90 [BRONCHIAL ASTHMA IN ACUTE EXACERBATION 1 peel oa 4.24%! INTERSTITIAL NEPHRI Becoou 107[HYPERTENSIVE HEART DISEASE WITHOUT [concestie) sean aituse: HYPERTENSIVE 565,200 6 nis Jean oisease nos i) 2230, ESSENTIAL IVPERENSTON WAUGNANT 110.9 HYPERTENSION #opiau0 ay 1.70%! CONCUSSION; CONMOTO CHREDRT WTTHOUT aes a soo Oren wrRAcRaNaL WOUND) : 1534 rea FEBRILE CONVULSTONS 70500 zi 168 rernc/ asrroouovenat vice, UNSPECIFIED AS ACUTE OR CHRONIC, WITHOUT 204,960 a6 27s AE MORRHAGE OK PERFORATION 125% fore Sorc maracas ieee zee Ta0.50% D. Claims Paid For Top 15 RVS Codes ——— — Total Weekly Amount of |Total Weekly No} Percentage Brae ee ea numeetiure Descriyton Claims Paid ofClaims Paid | Distribution 90935 [HEMODIALYSIS PROCEDURE 3,630,700 929} 35.35%) ROUTINE OBSTETRIC CARE INCLUDING |ANTEPARTUM CARE, VAGINAL DELIVERY JAND/OR POSTPARTUM CARE (NORMAL [SPONTANEOUS DELIVERY PACKAGE) FOR losprrats 2,249,500 439] 16.72% ROUTINE OBSTETRIC CARE INCLUDING PRENATAL, DELIVERY AND NEWBORN SERVICES JOF NON-HOSPITAL FACILITIES (MATERNITY Jacror [CARE PACKAGE) 3,330,000 415] 15,8094 90375 [ANIMAL BITE 828,000] 276] 10.51% 50513 CAESARUAN SECTION PRART ib 706.00 2a 3544 FPOoL [SUBDERMAL CONTRACEPTIVE IMPLANT 204,000 6a] 2.5994] 50514 ICESARIAN DELIVERY 1,268,000] 64] 2.4496) 99432 [NORMAL NEWBORN CARE PACKAGE 306,480] a 2.44%] DIRECTLY OBSERVED TREATMENT SHORT ——]— leo221 COURSE; INTENSIVE PHASE 137,500] 55 2.099%] DIRECTLY OBSERVED TREATMENT SHORT- ls9222 COURSE; MAINTENANCE PHASE 72,000} 4s] 1.8344 [26408 [CHEMOTHERAPY ADMINISTRATION 331,720 4H] 7.68%[58300 [INSERTION OF INTRAUTERINE DEVICE (IUD) 316,100] 32 1.22%] [POOOO [RESUSCITATION PACKAGE 120,000] 30 114%} S009 [VAGINAT-DELIVERY ONLY (W] EPISTOTOM] TSAO ay Tam 44950. [AFPENDECTOM 656,020] 27 1.03% TOTAL 15,668,420} 2,626] 10.00%] Prepared by: Reviewed by: Certified Tpueand Correct: DR. ROSARIO B. SUYOM LEO "DOUGLAS*¥- CARDONA, JR., MD, CSE v ‘MO VII /Chier HCDMD Regional Vice-President 1/OIC-PLANNING UNITANNEX B PHILHEALTH REGIONAL OFFICE VIII Status of Legal Cases Forth period September 30-October 4, 2019 A. Collection Cases Date Filed “| Respondent's Name | Category of Respondent Violation (ember, Employer, Provider) As of this reporting petiod, the Legal Oflice cos wes to prepare 48 case folders for filing before the Pr B. Hospital Cases Date Filed | Respondent's Name | Category of Respondent Violation (Member, Employer, Provider) 1. On October 3, 2019, the Legal Office has transmitted to FFIED six (6) Complaint Affidavits Against © Extending Period of Confinement, as follows: Catan Hospi Provider (Hospital) = Incorporated ider (Hospi Information; Breach of (for the claim of pati Page t of 3Date Filed Respondent's Name Category of Respondent Violation Staius/ Disposition Gacluding Date of (Member, Employer, Provider) Disposition) 10/3/2019 Catarman Doctors Provider (Hospitah ition of Provisions of LA. 7875, as amended | no disposition yer; documents still in (forwarded to | Hospital, Incorporated by RA 9241 and RA 10608 (0 wit transit to FFEED c Extending Period of Confinement, Mistepresentation by Fur © or Incorrect, Information; Breae! (for the of Performance Comminent m of patient JORGEN D. UMBANA) 107372019 (forwarded to GSU for Mailing| FIED) tok Catarman Doctors Hospital, Incorporated Provider (Hospital) f patient SOPHIA ATHENA $. ORTIZ) 3729 Forwarded to |GSU for Mailing| to FFIED) Doctors \corpomted Provider (7 pital) Violation of Provisions of A, 7875, as amex by RA 9241 and RA 10606 to wit Extending Period of Confinement; im of aula CRISTITA T. AMARANTO) no disposition yer; documents stil in transit to FFI ‘Catarman Doctors Hospital, Incorporated Violation of Provisions of RA. 7 Mistepresentation by Furnishing False or Incortect, Information; Breach of Performance Commitment (for the claim of patient JUAN GABRIEL D. TAN) no disposition yet; docume: transit to FFIED aud Team has been drafting the Fact-Findi [Fraudulent Claims filed by Western Leyte Provincial Hospital for Alveolectomy and Alveoplasty Cases. ing Investigation Report (FFIR) on the Suspected Page 2063Date Filed Respondent's Name Category of Respondent (Memes, Employer, Provider) Violation Status/ Disposition (including Dae of [Suspected Fraudulent |3. On October 2-4, 2019, the Legal Office Anti-Fraud Team Conducted ims filed by Ormoc District Hospital for Alves Disposition) Fact-Finding Investigation and Domiciliary Visits (Patient Interviews) on the ‘olectomy and Alveo| ty Cases, Prepared by: OU OFFICAL THAUEL Atty. ANITA LOURDES C. ORIEL Iv ad, Legal Office Cettified (vies LEO "DOUGLAS" V. CARDONA, JR., M.D., CSE Pres Page 3 of 3PHILHEALTH REGIONAL OFFICE VIII Updates of PRO VIII Initiatives in the Implementation and Facilitation of UHC Act and UHC Integration Sites September 30 - October 4, 2019 iG ee LEO "DOUGLAS" V. CARDONA, JR., Regional Vice-President Page 1 of 4INTRODUCTION Down with two remaining cities that will pass an ordinance and resolution to implement the UHC Health Integration System, namely, the City Government of Tacloban and City Government of Ormoc, PhilHealth Regional Office VIII did not waste any time to continue its effort toward this goal. On- going negotiations were made with the City Government of Tacloban and Ormoc for this week (September 30-October 3, 2019) and in principle, the Local Chief Executives of both Cities already signified their intention to support the program. Meeting with the Committee on Health of the City Government of Tacloban with its chair, Dr. Maria Elvira Casal. This was attended also by the Chair on Committee on Laws, Atty. Vangie Esperas, City Health Officer Dr. Gloria Fabrigas, DOH Reps Dr. Antonio Ida and Marvin Guyjoco, held last October 1, 2019. The team from PhilHealth Regional Office VIII, led by Field Operations Division Chief Acisclo B. Militante, Jr., Tacloban Local Health Insurance Office (LHIO) head, Richard Mauro Bugho and Tacloban LHIO staff and area coordinator, Abegail Dy had a meeting with the members of the Local Health Board of Tacloban City with representatives from the Department of Health. For the City Government of Tacloban, in attendance were Committee on Health Chair, Dr. Maria Elvira Casal, Committee on Laws Chair, Atty. Vangie Esperas and City Health Officer Dr. Gloria Fabrigas. For the Department of Health, in attendance were DOH Reps Dr. Antonio Ida and Mr. Marvin Guyjoco. Page 2 of 4PhilHealth discussed the Health Integration System which are now approved in the provinces in Eastern Visayas except the Province of Leyte through an Ordinance or Executive Order after having passed before the Sangguniang Panlalawigan of every province in region 8. Mr. Acisclo B. Militante, Jr, division chief of PhilHealth RO VIII, represented RVP Leo “Douglas” V. Cardona, Jr., MD (the latter who was on travel) and discussed the model of the proposed health integrated system. The Local Health Board members led by its chair Dr. Maria Elvira Casal and DOHRep Dr. Antonio Ida supported the proposal. However, according to Atty. Vangie Esperas, Chair of the Committee on Laws, they will just support whatever will be incorporated or agreed by the Local Health Board since it was already there and the board decides what is good in terms of the city's health system. According to them, they will concur in passing a resolution supporting the decision of the Local Health Board with regards to the City-wide Integrated Health System. The group from PhilHealth and DOH will attend the October 2, 2019 Sangguniang Panlalawigan session. Sangguniang Panglungsod ng Tacloban Session held last October 2, 2019. Present from PhilHealth during the session were Division Chief Acisclo 8. Militante, Jr., Richard Mauro Bugho and Abegail Dy. As a follow through, PhilHealth Regional Office VIII represented by Mr. Acisclo B, Mlitante, Jr., together with other staff, Richard Mauro Bugho and Abegail Dy attended the Sangguniang Panglungsod Session in Tacloban City last October 2, 2019. Present also were from the Department of Health-CHD VIIL Dr. Antonio Ida, DOH representative, and Mr. Marvin Guyjoco. Mr. Acisclo B. Militante, Jr. was allowed to present the UHC Law particularly on Section 19 Page 3 of 4and 20 of RA 11223. He presented the benefits under the new law as compared to the old RA 10606, amending RA 9241, covering all Filipinos and expanding the benefits thereof. As a result, the Sangguniang Panglungsod has signed a resolution supporting the Local Health Board resolution on the integrated city-wide Health system and endorsing it to PhilHealth and DOH. The resolution is now for signature by the presiding chair, Vice-Mayor Jerry "Sambo" Yaokasin. The Executive Order will follow also to be signed by Mayor Alfred Romualdez while waiting for the signed SP resolution. Accordingly, there is a draft Executive Order on this. Page 4 of 4