NHIP Claims Check Follow-up Guidelines

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PHILHEALTH OFFICE ORDER NO. 196, S. 1999: NHIP Claims Check Follow-up Guidelines

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Title Supreme Court: NHIP Claims Check Follow-up Guidelines

Law: Philhealth Office Order No. 196, S. 1999

Decision Date: May 10, 1999

PhilHealth Office Order No. 196 establishes streamlined guidelines for the follow-up of NHIP claims checks, limiting claimant interactions to two minutes and encouraging direct filing through hospitals to expedite reimbursements.

administrative law

health insurance

A

Procedure for Claimants Following Up on NHIP Checks

Each claimant is allowed a maximum of 2 minutes for personal follow-up
A designated check releasing staff member will handle the follow-up process
Staff must record the following claimant details:
- Name
- Address
- Contact telephone numbers
- Name of patient if different from claimant
- Hospital where the patient was confined
- Period of confinement

Follow-Up Instructions Post Initial Data Collection

Claimant is directed to either:
- Return after one week, or
- Wait for a call within one week from PHIC for further instructions
Check releasing staff has the responsibility to contact the claimant within one week
The purpose of the call is to prepare the claimant with required data for final processing

Policy on Claims Filing

Direct filing of NHIP claims by members to PHIC is discouraged
NHIP members are encouraged to file claims through the hospital
Hospitals will deduct the expected NHIP reimbursement from the total hospital bills

Legal Authority and Adoption

These guidelines were adopted on May 10, 1999
Issued by the President and CEO of Philippine Health Insurance Corporation (PHIC), Enrique M. Zalamea
Intended to guide all concerned parties in claim check release and claim filing procedures

END