Public 9162023

www.philhealth.gov.ph PhilHealthOfficial teamphilhealth actioncenter@philhealth.gov.
ph
www.philhealth.gov.ph PhilHealthOfficial teamphilhealth actioncenter@philhealth.gov.ph
STEP 1: REGISTRATION
OPTIONS IN REGISTERING TO A FACILITY
Log-in to the Member Portal or Member Online
1
Registration through PhilHealth Website and
Register
(www.philhealth.gov.ph)
Self Registration
Screen shot and/or print the confirmation
2
message as proof the you have been already
registered to a PhilHealth Konsulta Facility

ASSISTED REGISTRATION TO A FACILITY
Employer
1
Fill-out the PhilHealth Konsulta
Social Worker of the PhilHealth Registration Form
Konsulta Provider (if any)
Local Government Unit (LGU)

or Office for Senior Citizens Affairs The assisting office shall:
(OSCA) ✔ generate the confirmation receipt with QR
2
Code
PhilHealth Local Health Insurance ✔ print or take a digital image of the QR Code
Office (LHIO) through beneficiary’s camera or release the
confirmation slip (beneficiary’s copy of the
PhilHealth Konsulta Registration Form)
PhilHealth Customer Assistance,
Relations, and Empowerment Staff
(P-CARES)
ASSISTED REGISTRATION TO A FACILITY
1 Call 02-8441-7442
PhilHealth Corporate Action Center
2
(CAC) Answer the Security Questions
Get the Registration

3 Confirmation Details

• Php 500.00
(Government)

Sample computation for the First Tranche for Public facility
Month Number individuals Number of registered with Calculation Sample Capitation
Year 2022
registered per month encountered data record per
month
Jan 2,000 2,000 2,000* 200.00 *(12/12) 400,000.00

Feb 2,000 2,000 2,000 * 200.00* (11/12) 368,000.00
Mar 1,500 1,500 1,500 * 200.00 * (10/12) 249,000.00
Apr 3,500 3,500 3,500* 200.00 * (9/12) 525,000.00
May 2,000 2,000 2,000 * 200.00 * (8/12) 264,000.00
Jun 1,000 1,000 1,000 * 200.00 * (7/12) 116,000.00
Jul 500 500 500 * 200.00 * (6/12) 50,000.00
Aug 1,500 1,500 1,500 * 200.00 * (5/12) 126,000.00
Sep 2,500 2,500 2,500 * 200.00 * (4/12) 165,000.00
Oct 1,000 1,000 1,000 * 200.00 * (3/12) 50,000.00
Nov 1,500 1,500 1,500 * 200.00 * (2/12) 48,000.00
Dec 1,000 1,000 1,000 * 200.00 * (1/12) 16,000.00
Total 20,000 20,000

2,377,000.00

Sample computation for the First Tranche for Public facility
Revision 2
Second Tranche = No. of registered beneficiaries with first patient encounter ×

40% of Capitation Amount (Php200.00)
= 20,000× Php200.00
= Php4,000,000.00
= Php4,000,000.00

Total number of registered
member with encountered
data record for the year
Performance 2022 is 20,000.00
Indicators/Description
Based on you EMR/eKAS/ePresS
1 Primary Care Consultation: (100%) 100% of KonSulTa registered beneficiaries
Unique registered beneficiaries consulted a primary care experienced the “First Patient
doctor Encounter”/Consultation.
= 20,000
2 Utilization of Laboratory Services: (50%)
Out of 20,000 KonSulTa registered beneficiaries ,
Unique laboratory services done
50% of them had laboratory services .
3 Dispensing of Medicines: (15%) = 10,000
Unique registered beneficiaries who received antibiotics Out of 20,000 KonSulTa registered beneficiaries ,
as prescribed by their primary care doctor 15% of them received antibiotics.
= 3,000
4 Dispensing of Medicines: (20%)
Out of 20,000 KonSulTa registered beneficiaries ,
Unique registered beneficiaries who received NCD
20% of them received NCD medication.
medication as prescribed by their primary care doctor = 4,000

Sample computation for the Second Tranche
Sample Computation
Performance Score Formula:
per Resultant Score
Indicators/Description (Score/Target) × Weight
Dimension
a not to exceed 100%
1 Primary Care Consultation: (100%) (100/100)*0.30
Unique registered beneficiaries consulted a primary care 100% No. of unique individuals who consult at 30%
doctor least one/Total catchment population
2 Utilization of Laboratory Services: (50%) (50/50)*0.30
Unique laboratory services done 50% No. of unique laboratory service 30%
done/Total catchment population
3 Dispensing of Medicines: (15%) (15/15)*0.10
Unique registered beneficiaries who received antibiotics 15% No. of unique individuals who received 10%
as prescribed by their primary care doctor medicines for communicable
diseases/Total catchment population
4 Dispensing of Medicines: (20%) (20/20)*0.30
Unique registered beneficiaries who received NCD 20% Total of unique individuals who received 30%
medication as prescribed by their primary care doctor non-communicable medicines/Total
catchment population
Performance Factor 100%

For Public facility
Second Tranche = No. of registered beneficiaries with first patient encounter × Performance Factor ×
60% of Capitation Amount (Php300.00)
= 20,000× 100% × Php300.00

= Php6,000,000.00
= Php6,000,000.00 + Php 4,000,000.00 1 st

Tranche
= Php10,000,000.00 (Total Capitation Fund)

No. PC No. 2022-0005 PC No. 2023-0013
1. SAP1 pro rata computation PRO rata computation is terminated

effective January 1, 2023.
2. Denominator in SAP2 is based on the number Change in denominator in SAP2

of registered beneficiaries to a Konsulta effective January 1, 2022.
Package Provider (KPP).
3. All Filipinos shall be eligible to avail of the All Filipinos and other qualified
PhilHealth Konsulta benefit. PhilHealth beneficiaries shall be
eligible to avail of the PhilHealth
Konsulta benefit.
Prioritize Filipinos in the implementation

of PhilHealth Konsulta benefit. MMG
shall release a circular on the
entitlements of foreign nationals.
www.philhealth.gov.ph PhilHealthOfficial teamphilhealth actioncenter@philhealth.gov.ph 27

No. PC No. 2022-0005 PC No. 2023-0013
4 Registration shall be done through the Registration shall be done through the
following: following:
a. Member-initiated a. Member-initiated
b. PhilHealth Assisted b. PhilHealth Assisted (through LHIOs
and PCARES) and Initiated
Registration
c. Third-party assisted
5. Transfer to another KPP Transfer to another KPP
a. Within the current year: a. Within the current year:
 Withdrawal, non-renewal, or suspension of  No FPE done
accreditation of the KPP  KPP ceases to operate due to
 Closure of the KPP; circumstances beyond its control
 Any other instances identified by the  KPP ceases to operate due to
Corporation. negligence
b. For succeeding year:
b. For succeeding year: Last quarter of the year
Last quarter of the year

No. PC No. 2022-0005 PC No. 2023-0013
6. PhilHealth Konsulta Provider shall not engage in KPPs shall be allowed to conduct social
“active patient seeking” or the practice of hiring mobilization and social marketing to promote
seekers/recruiters for the purpose of populating the the PhilHealth Konsulta benefit. Promotional
registration registry to meet the maximum catchment activities include, among others, oral
population. presentations, social marketing campaigns,
and posting and distribution of written
information, education, and communication
materials. KPPs shall coordinate with
PhilHealth PROs for branding and
communication guidance.
7 The maximum catchment population shall be subject The counting of the current catchment
to PhilHealth assessment, and approval based on the population already empaneled with the KPP,
health human resource to population ratio as which determines if a KPP can still accept
stipulated in the accreditation policy of PhilHealth additional beneficiaries, shall be based on
KPP. the actual count of FPE done.
Thus, this statement amends the

denominator in the SAP2 computation.

No. PC No. 2022-0005 PC No. 2023-0013
8. Nurse, midwives and The following may render an FPE on behalf of the KPPs:
doctors may conduct
the FPE. 1.1. Barangay health workers (BHWs) of the barangay health
stations (BHS) under supervision of the accredited KPP;
1.2 Nurses and midwives of the BHS and/or RHU of the accredited
KPP;
1.3 Medical clerks or interns authorized by their training institutions
and under supervision of the accredited KPP;
1.4 Nurses of on-site clinics of employers with accredited KPP; or
1.5 Physicians of accredited KPPs.
9. KPP shall take a In the policy, photo consent form is available.

photo if ATC is not
available.

No. PC No. 2022-0005 PC No. 2023-0013
10. eKASs and Only in situations where the system generated

ePresS shall be EKAS and EPRESS are not available, the KPP may
system accomplish blank EKAS and EPRESS, in duplicate
generated. copies, both to be signed by the Konsulta
beneficiary. One copy shall be given to the Konsulta
beneficiary and the other copy shall be encoded
later on. There is no need to attach a printed EKAS
and EPRESS to the generated SAPs. If the
beneficiary is unable to write, they may affix their
thumbmark.
EKAS and EPRESS forms were revised also.

No. PC No. 2022-0005 PC No. 2023-0013
11. The conduct of the The first tranche for the succeeding years of retained
FPE within the year beneficiaries will be paid in full without need for another FPE,
of registration shall provided that the KPP conducted at least one medical
be the shared consultation for the beneficiary within the previous year. If the
responsibility of the KPP did not conduct at least one medical consultation within the
accredited previous year, a new FPE must be performed in the succeeding
PhilHealth year to avail of the first tranche of capitation payment.
Konsulta Providers
and all newly This is an incentive for the KPP to facilitate empanelment of
registered eligible primary care catchment population. Retention of beneficiaries is
beneficiaries. in itself a key feature of primary health care. This allows for
better quality of care, as the KPP becomes familiar with the
medical history and course.

No. PC No. 2022-0005 PC No. 2023-0013
12. All health data shall For encoding purposes, only the following data fields shall
be encoded in the be required for FPE: PhilHealth Identification Number (PIN),
Konsulta compliant Name (Last, First, Middle, Extension), Date of Birth,
EMR system.
Biological Sex (Male/Female), Client Type, and Vital Signs
and Anthropometrics.
Other data including but not limited to other parts of the

patient history and physical exam, diagnosis, diagnostic
tests done with corresponding results and
prescribed/dispensed medicines, other services and
commodities not currently covered by the package shall be
only required for the generation of SAP2.


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www.philhealth.gov.ph PhilHealthOfficial teamphilhealth actioncenter@philhealth.gov.

Log-in to the Member Portal or Member Online

www.philhealth.gov.ph PhilHealthOfficial teamphilhealth actioncenter@philhealth.gov.ph

Local Government Unit (LGU)

PhilHealth Corporate Action Center

Get the Registration

www.philhealth.gov.ph PhilHealthOfficial teamphilhealth actioncenter@philhealth.gov.ph

www.philhealth.gov.ph PhilHealthOfficial teamphilhealth actioncenter@philhealth.gov.ph

Jan 2,000 2,000 2,000* 200.00 *(12/12) 400,000.00

Total 20,000 20,000

www.philhealth.gov.ph PhilHealthOfficial teamphilhealth actioncenter@philhealth.gov.ph

Second Tranche = No. of registered beneficiaries with first patient encounter ×

www.philhealth.gov.ph PhilHealthOfficial teamphilhealth actioncenter@philhealth.gov.ph

www.philhealth.gov.ph PhilHealthOfficial teamphilhealth actioncenter@philhealth.gov.ph

www.philhealth.gov.ph PhilHealthOfficial teamphilhealth actioncenter@philhealth.gov.ph

= 20,000× 100% × Php300.00

= Php6,000,000.00 + Php 4,000,000.00 1 st

= Php10,000,000.00 (Total Capitation Fund)

www.philhealth.gov.ph PhilHealthOfficial teamphilhealth actioncenter@philhealth.gov.ph

1. SAP1 pro rata computation PRO rata computation is terminated

2. Denominator in SAP2 is based on the number Change in denominator in SAP2

Prioritize Filipinos in the implementation

www.philhealth.gov.ph PhilHealthOfficial teamphilhealth actioncenter@philhealth.gov.ph 27

www.philhealth.gov.ph PhilHealthOfficial teamphilhealth actioncenter@philhealth.gov.ph 28

Thus, this statement amends the

www.philhealth.gov.ph PhilHealthOfficial teamphilhealth actioncenter@philhealth.gov.ph 29

9. KPP shall take a In the policy, photo consent form is available.

www.philhealth.gov.ph PhilHealthOfficial teamphilhealth actioncenter@philhealth.gov.ph 30

10. eKASs and Only in situations where the system generated

EKAS and EPRESS forms were revised also.

www.philhealth.gov.ph PhilHealthOfficial teamphilhealth actioncenter@philhealth.gov.ph 31

www.philhealth.gov.ph PhilHealthOfficial teamphilhealth actioncenter@philhealth.gov.ph 32

Other data including but not limited to other parts of the

www.philhealth.gov.ph PhilHealthOfficial teamphilhealth actioncenter@philhealth.gov.ph 33

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