PhilHealth Newborn Care Package Guidelines

PhilHealth Circular No. 20, s. 2007 is issued pursuant to PhilHealth Board Resolution No. 1060 series of 2007.
PhilHealth Board Resolution No. 1060 series of 2007 amends PhilHealth Board Resolution No. 925, s. 2006.

The circular establishes guidelines on the implementation of the PhilHealth Newborn Care Package (NCP).
The NCP package covers eligible newborn cases delivered in accredited facilities and enumerated services needed to deliver newborn care.
The circular sets reimbursement rules that require facilities to be able to provide all required package services.

The package shall cover all eligible newborn-dependence delivered in all accredited health facilities.
Coverage includes non-hospital maternity health care providers.
Facilities must be PhilHealth-accredited (existing accredited facilities) or facilities applying for initial, renewal, and re-accreditation.
A DOH-authorized newborn screening certification requirement applies to qualify as an NCP service provider.
Claims reimbursement rules apply specifically to PhilHealth accredited facilities for NCP with admission beginning January 1, 2008.

The services covered by the package include administration of BCG vaccine.
The services covered by the package include resuscitation of the newborn.
The NCP package amount is fixed at P1.000.
Health care facilities must be able to provide all required services covered by the package.
If a facility cannot provide the complete services covered by the package, claims from that facility shall not be compensated.
Members may still be paid within the amount of the package item enumerated in PhilHealth Circular No. 34, s. 2006, if Official Receipt/s are attached to the claim application.

Newborn Screening (NBS) is ideally performed after twenty four hours of life.
NBS must be performed not later than three (3) days from complete delivery to qualify under the standard timing.
Claims for NCP within the three (3) days period shall be compensated.
Newborns placed in intensive care to ensure survival, and premature and sick newborns, may be exempted from the three-day requirement.
For exempted cases, NBS must be tested within seven (7) days of age.
Official Receipt/s for NBS dated within the same period (even after discharge of the patient/newborn) shall be covered by the package.

Facilities must submit a photocopy of a Newborn Screening Facility (NSF) certificate issued by the Department of Health (DOH) or Newborn Screening Reference Center (NSRC).
The submission must be made to the Accreditation Department or Accreditation Section of PhilHealth Regional Offices (PROs).
The deadline for submission is on or before December 31, 2007.
Claims of PhilHealth accredited facilities for NCP with admission beginning January 1, 2008 that are not certified by DOH or NSRC as NSF shall not be reimbursed.

Facilities must indicate the filter collection card number of the NBS specimen and collection form in Part IV (C) item no. 3 of the claim form.
If a facility cannot indicate the filter collection card number, the claim form must be returned to the facility.
All services covered by the package must be enumerated in Part IV (C) of the claim form.
The claim form enumeration in Part IV (C) includes:
- Eye prophylaxis, umbilical cord care, Vitamin K, thermal care, administration of BCG vaccine & resuscitation of the newborn
- 1st dose of Hepatitis B immunization
- Newborn Screening Test (filter collection card number)
To facilitate speedy processing, Claim Forms 1 and 2 must be submitted together with maternal application within the prescribed period.
All claim applications for NCP must be coded using RVS code 99432.
The descriptive term for RVS 99432 is Normal Newborn Care Package.
PhilHealth rules on ICD-10 apply for this package.

NCP claim applications must include:
- duly accomplished Forms 1 and 2
- certificate of live birth
- clear copy of Member Data Record
- proof of premium payment

Claims from a facility that cannot provide the complete services covered by the package shall not be compensated.
Claims for NCP with admission beginning January 1, 2008 shall not be reimbursed if the facility is not certified by DOH or NSRC as NSF.
Reimbursement inconsistency is addressed by repealing benefit availment rules inconsistent with the NCP guidelines for the covered claims effectivity period.