Prevention of Unclaimed or Unrefunded Reimbursements
- The submission of SA or BS helps prevent accredited health care providers from accumulating unclaimed or unrefunded PhilHealth reimbursements.
- This provision runs parallel to PhilHealth Circular No. 14, s. 2007.
Required Contents and Authentication of SA or BS
- The final SA or BS must be issued on the patient’s discharge day.
- It should clearly indicate the PhilHealth deductions on both hospital charges and professional fees.
- The document must be duly signed by the member or their authorized representative.
- The signatory must print their name, state their relationship to the member, and provide a contact number.
- The signatory confirms or concurs with the statements regarding PhilHealth deductions.
- Preferably, the signatory on the SA or BS should be the same person who signed PhilHealth Claim Form 1, item No. 13.
- If different signatories are involved, information about the authorized representative needs to be included on the SA or BS (name, relationship, contact number).
- The accountant or billing clerk’s signature over their printed name and position is also required.
Member’s Copy and Option for Additional Documentation
- A copy of the SA and the corresponding official receipt (OR) must be given to the member upon discharge.
- The member can choose to attach the OR as supporting documentation for the reimbursement of any remaining benefits.
Compliance with Claim Form Requirements and Handling Discrepancies
- Submission of SA or BS is required without prejudice to the proper completion of PhilHealth Claim Form 2, particularly Parts 3 and 4.
- When the SA or BS format does not provide itemized charges, proper completion of Claim Form 2 remains mandatory.
- Should discrepancies arise between the claim amount in Claim Form 2 and the SA, the amount deducted by the provider as reflected in the SA and supported by the OR shall be the definitive basis for reimbursement.
Implementation Schedule by Region and Hospital Category
- Implementation will be phased to allow accredited providers time to adjust:
- February 1, 2008: National Capital Region (NCR) and PRO VI for Levels 3 and 4 hospitals.
- April 1, 2008: Remaining PROs including CAR I, II, III, IVA, IVB, V, VII, VIII, IX, X, XI, XII, CARAGA for Levels 3 and 4 hospitals.
- June 1, 2008: All PROs for all hospital levels.
- Post-implementation, all claim applications lacking an SA or BS will be returned for compliance except claims under the TB-DOTS package.
Legal Authority and Administration
- The circular was adopted pursuant to Rule VIII Section 47 of the Implementing Rules and Regulations of RA 7875, as amended.
- Signed and issued by the Acting President and CEO of PhilHealth, ensuring organizational compliance and enforcement.