Policy Objective and Partnership Purpose
- The Circular strengthens PhilHealth’s partnership with accredited Institutional Health Care Providers (IHCPs).
- The Circular provides IHCPs access to a web-based Portal.
- The Portal supports on-line verification of Sponsored Program (SP) Members under NHTS-PR during benefits availment.
IHCP Portal: Coverage and Linkage
- The IHCP Portal establishes an on-line link between accredited IHCPs and PhilHealth for eligibility verification of Sponsored Members (NHTS-PR).
- The eligibility verification supports benefits availment by Sponsored Members and their dependents under NHTS-PR.
- The Portal verifies the following eligibility information:
- The PhilHealth Identification number (PIN).
- The member’s name and date of birth.
- The member’s declared dependent/s.
- The Portal is structured to enable later incorporation of significant modules, including e-logbook, benchbook, and MMHR, to expand efficiency of on-line transactions between accredited IHCPs and PhilHealth.
IHCP Portal: Participation Requirements and Access
- Accessibility/Linkage to IHCP portal is open to all qualified accredited IHCPs.
- Before registration proper, an IHCP must have:
- IT hardware:
- Computer.
- Printer.
- Internet connection.
- IT hardware:
- IHCPs participate through a defined registration and installation process tied to PhilHealth verification and approval.
IHCP Portal Registration and Installation Process
- IHCPs access the PhilHealth online application by visiting philhealth.gov.ph to use the PhilHealth Online Access Form (POAF, No. 002) module.
- IHCPs download the application form and its attached certificate of non-disclosure agreement through the POAF module.
- An IHCP submits the accomplished POAF and certificate of non-disclosure agreement to the Health Care Delivery and Management Division of the PhilHealth regional Office for proper verification and evaluation.
- After approval and evaluation by PhilHealth, PhilHealth visits the qualified IHCP for installation of the IHCP portal.
- PhilHealth provides orientation on the portal’s application upon installation.
- The facility is ready for verification once installation and orientation are completed.
Eligibility Verification and Reference Number Generation
- Eligibility verification using the IHCP Portal is conducted at the facility level before the Sponsored Member and dependents under NHTS-PR avail PhilHealth benefits.
- If the SP member under NHTS-PR is verified through the Portal, a Reference Number (RN) is generated.
- The generated RN is based on the following information:
- Accreditation Number.
- Name of hospital.
- Name of patient.
- Confinement period.
- Name of member.
- Date of coverage.
- Account name of computer operator that accessed the IHCP Portal.
- The generated RN must be attached to the claims replacing the MDR and other secondary documents such as birth certificate, marriage contract, and the like.
- Properly accomplished PhilHealth Claim Form 1 remains required for claims submission.
E-Claims Project Participation Rule
- IHCPs enrolled in the e-claims project are no longer required to apply for installation of the IHCP portal.
- Eligibility verification of Sponsored Program Members under NHTS-PR is covered by the e-claims project for IHCPs already enrolled.
Availability, Repeal/Modification, and Administrative Register
- The IHCP Portal is made available starting fifteen (15) days after publication of PhilHealth Circular No. 002-2012 in a newspaper of general circulation.
- The Circular is deposited thereafter with the National Administrative Register at the University of the Philippines Law Center.
- All provisions of previous issuances that are inconsistent with any provision of the Circular are repealed/modified or amended accordingly.