Question & AnswerQ&A (PHILHEALTH CIRCULAR NO. 68, S. 1999)
The purpose is to reduce the incidence of claims being returned to hospitals due to deficiencies and to maximize the availment of PhilHealth benefits by implementing specific policies for processing Medicare claims.
Yes, one claim may be filed for multiple outpatient procedures indicating multiple dates in Form 2, including hemodialysis, chemotherapy, and radiotherapy.
Such claims shall be processed but only hospital charges will be paid; professional fees will not be paid.
Claims without actual charges for professional fees shall be returned to the hospital for completion.
The physician may request payment by submitting within 60 days the following to RHIO/Central Office: a letter requesting adjustment, a photocopy of PhilHealth Form 2 with original signature, and a photocopy of the paid claim voucher.
Requests for adjustment of payment claims must be filed within 60 days from receipt of PhilHealth Check and Voucher by the hospital and member.
Adjustments relative to PhilHealth Circular No. 52, s. 1999 regarding increase in NHIP benefits are excluded.
Yes, provided the dependents declared by one parent shall no longer qualify as dependents of the other parent.
The Bank Account Passbook is honored for retiree pensioners' claims.
No, as long as the employer signs PhilHealth Form 1 certifying the truth of the data supplied, no additional proof of dependency is needed.
The whole claim shall still be considered for processing.
Claims must be supported by original official receipts duly issued by the hospital, pharmacy, or attending physician. Tape receipts are not accepted.