Question & AnswerQ&A (PHILHEALTH CIRCULAR NO. 22, S. 2007)
The main purpose is to require the submission of the Statement of Accounts (SA) or Billing Statements (BS) together with the Official Receipt of payment by the member as attachments to PhilHealth claims applications to ensure reimbursements are provided to the rightful beneficiaries.
The requirement arises from Rule VIII Section 47 of the Implementing Rules and Regulations of Republic Act 7875 as amended.
The documents required are the Statement of Accounts (SA) or Billing Statements (BS) or their equivalent, and the Official Receipt (OR) of payment by the member to the hospital.
The SA/BS must be the final statement issued on the day of the patient’s discharge, indicate PhilHealth deductions on hospital charges and professional fees, be duly signed by the member or authorized representative with printed name, relationship, and contact number, and have the signature over printed name and position of the accountant or billing clerk.
The SA/BS must be signed by the member or his/her authorized representative, with the signatory preferably the same as in PhilHealth Claim Form 1 (item No. 13). If different, the authorized representative’s details must be indicated.
The Official Receipt serves as proof of payment by the member and as a basis for the appropriate reimbursement of remaining benefits, if any.
In case of discrepancies, the actual amount deducted by the provider as stated in the SA and supported by the Official Receipt shall be the basis for reimbursement.
Yes, from the effective date onwards, all claim applications without SA or BS will be returned for compliance, except for claims for the TB-DOTS package.
The requirement became effective on February 1, 2008.
For NCR and PRO VI levels 3 and 4, effective February 1, 2008; for other PROs (CAR I, II, III, IVA, IVB, V, VII, VIII, IX, X, XI, XII, CARAGA) levels 3 and 4, effective April 1, 2008; and for all PROs at all hospital levels, effective June 1, 2008.