PHIC PHILHEALTH CIRCULAR NO. 27, S. 2009

: Professional fees designated for pooling must be paid to the professionals who actually rendered the service, and the signatory in Part II of Claim Form 2 should be the service provider.
: The professional who actually rendered the service should be the signatory in Part II of Claim Form 2.
: The phrase 'PAY TO DIRECTOR/ADMINISTRATOR/CHIEF' should be indicated.
: Daily visit is based on the rate for non-specialists, using a PCF of 40 in the computation regardless of the accreditation category of the signatory.
: If the Medical Director, Administrator, Chief of Clinics, or Department Heads actually rendered the service as evidenced by attached documents, the professional fees shall be computed based on their accreditation category.
: Preoperative inpatient consultation, pathology services, radiology services, and fluorescent angiography are limited to specific specialist groups such as Diplomates or Fellows of relevant societies listed in Table 1.
: Such claims shall be disallowed.
: Yes, claims can be compensated with PCF 40 generally, or PCF 56 if the signatory actually rendered the service and complies with Table 1.
: They shall only be paid based on a maximum of 80 RVU in Level 2, 3, and 4 hospitals, except for salaried physicians in government or private training hospitals and procedures performed in PhilHealth-designated shortage areas.
: The Circular took effect for all claims with admission dates starting April 5, 2009.