QuestionsQuestions (BATAS PAMBANSA BLG. 76)
It requires that the Statement of Accounts (SA) or Billing Statements (BS) (or equivalent) together with the Official Receipt (OR) of payment by the member to the hospital be attached to the PhilHealth claims application.
It is stated to be in relation to Rule VIII, Section 47 of the Implementing Rules and Regulations (IRR) of Republic Act No. 7875, as amended.
As basis for (1) reimbursing the hospital the actual amount of benefit deducted from members’ hospitalization charges and (2) ensuring that the member receives the remaining benefit (difference between the deducted amount and the maximum allowable benefit based on illness case type and hospital category, if any).
The Official Receipt of payment by the member to the hospital must also be attached.
The final BS/SA issued on the day of the patient’s discharge, indicating PhilHealth deductions on hospital charges and professional fees.
It must be duly signed by the member or the member’s authorized representative, with the printed name, relationship to the member, and contact number.
As much as possible, the signatory in the SA/BS must be the same person as the signatory in PhilHealth Claim Form 1 (item No. 13).
The SA/BS should include information for the authorized representative: name, relationship to the member, and contact number.
The SA/BS must have the signature over the printed name and position of the accountant or billing clerk.
A copy of the SA and corresponding Official Receipts must be provided to the member upon discharge.
Yes. The member has the option to attach the OR as basis for appropriate reimbursement of remaining benefits (if any).
It states that submission of the SA/BS and OR is without prejudice to the proper accomplishment of PhilHealth Claim Form 2 Parts 3 and 4, especially for SA/BS formats without itemization of charges.
The actual amount deducted by the provider as stated in the SA and supported by the Official Receipt shall be used as the basis for reimbursement.
After the effective date, all claim applications without SA or BS shall be returned for compliance, except claims for the TB-DOTS package.
Claims for the TB-DOTS package.
February 1, 2008 (for admission effective dates within NCR and PRO VI Levels 3 and 4).
April 1, 2008.
June 1, 2008.