Discontinuance of Cataract Surgery Claims

The circular is issued by PhilHealth through PHIC as a PhilHealth policy issuance.
PhilHealth Board Resolution No. 1046 s. 2007 directs the discontinuance and limitations addressed by this circular.
The circular implements Board direction to limit the number of claims that may be compensated under the program.
Effectivity is tied to admission dates starting November 1, 2007 for cataract operation claims.
Implementing guidelines are to be issued forthwith for compliance with the circular.

PhilHealth must discontinue compensability for cataract surgery claims arising from medical missions and other recruitment schemes.
PhilHealth must employ necessary measures to limit the number of cataract claims compensated under the program.
PhilHealth must limit claims by ascertaining the veracity of volume claims prior to processing and payment.
PhilHealth must issue implementing guidelines for compliance to operationalize the circular’s directives.

PhilHealth discontinues compensability of claims for cataract operations performed during medical missions.
PhilHealth discontinues compensability of claims for cataract operations performed through other recruitment schemes.
The discontinuance applies to cataract operation claims that fall under the stated circumstances beginning November 1, 2007 admission dates.

PhilHealth must limit the number of cataract surgery claims that may be compensated under the program.
PhilHealth must do so by ascertaining the veracity of volume claims.
PhilHealth must conduct the volume-veracity ascertainment prior to processing and payment.
The circular authorizes PhilHealth to use necessary measures to carry out the limiting directive.

PhilHealth must issue implementing guidelines for compliance forthwith.
PhilHealth must apply the circular to claims for cataract operations based on admission dates.
PhilHealth must execute compliance through its processing and payment controls that include pre-payment verification of volume claim veracity.

Any issuance inconsistent with PHIC PHILHEALTH CIRCULAR NO. 17 is repealed and modified accordingly.