Question & AnswerQ&A (PHILHEALTH CIRCULAR NO. 0036, S. 2013)
The main purpose is to clarify the provisions on indicating professional fees reimbursement in PhilHealth Claim Form 2 under the fee-for-service payment mechanism as outlined in PhilHealth Circular No. 9, Series of 2013.
It specifies that if the health care professional indicates terms such as zero or 0, complimentary, PhilHealth benefit, No PF, co/co./company in the boxes for total actual professional fee or amount paid by members, the professional fees shall be reimbursed to the health care professional.
Accredited health care professionals who provide services to PhilHealth members and indicate the proper terms in the claim form benefit from professional fee reimbursement.
Indicating 'complimentary' or 'PhilHealth benefit' either in words or amount in the relevant box entitles the health care professional to reimbursement of their professional fees by PhilHealth.
Its effectivity and coverage follow those of PhilHealth Circular No. 9, Series of 2013, which the circular clarifies.
The Circular must be published in a newspaper of general circulation and deposited with the National Administrative Register at the University of the Philippines Law Centre.
It is a payment mechanism where health care professionals are reimbursed based on actual services rendered as indicated in the PhilHealth claim forms, separate from service or hospitalization fees.
Because the success of the Universal Health Care program depends on their full cooperation and participation in provision of quality health services and facilitation of claims processing.
No, the Circular clarifies that indicating zero or zero amount in the relevant boxes for professional fees will still allow reimbursing the professional fee to the health care professional.
Alexander A. Padilla, President and CEO of PhilHealth, signed the Circular.