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(NAR) VOL. 23 NO. 1, JANUARY - MARCH 2012
[ PHILHEALTH CIRCULAR NO. 002-2012, January 17, 2012 ]
GUIDELINES ON THE IMPLEMENTATION OF INSTITUTIONAL HEALTH CARE PROVIDER (IHCP) PORTAL
I. OBJECTIVE
To strengthen PhilHealth’s partnership with accredited Institutional Health Care Providers (IHCPs) through access to a web-based Portal for on-line verification of membership status of Sponsored Program (SP) Members under the National Household Targeting System for Poverty Reduction (NHTS-PR) during benefits availment.
II. THE IHCP PORTAL
A. Sponsored Members (NHTS-PR) eligibility verification and IHCP profile
The IHCP portal is established to provide a link between accredited institutional health care providers and PhilHealth through an on-line connection that shall ensure verification of the following eligibility information of Sponsored Members under NHTS-PR for purposes of availment of PhilHealth benefits:
In addition to the abovementioned features and as part of the IHCP portal enhancement process, significant modules (e.g., e-logbook, benchbook, MMHR) shall eventually be incorporated to the said portal in order to expand the efficiency of on-line transaction between the participating accredited IHCPs and PhilHealth.
B. Requirements
Accessibility/Linkage to IHCP portal is open to all qualified accredited IHCPs. Prior to registration proper, IHCPs must have the following requirements:
C. Participation of the HCPs
The following are the steps in IHCP portal registration:
D. Generation of Reference Number
1. Eligibility verification using the IHCP portal shall be made at the facility level prior to the availment of PhilHealth benefits by the sponsored members and their dependents under NHTS-PR.
2. If the SP member under NHTS-PR has been verified through this portal, a reference Number (RN) will be generated based on the following information (see attached Annex C[*]: sample of reference number):
3. The generated RN shall be attached to the claims replacing the MDR and other secondary documents like birth certificate, marriage contract and the like.
4. Properly accomplished PhilHealth Claim Form 1 is still required for claims submission.
III. PARTICIPATION IN E-CLAIMS PROJECT
IHCPs that are currently enrolled in the e-claims project are no longer required to apply for installation of IHCP portal because eligibility verification of Sponsored Program Members under NHTS-PR is already covered by the abovementioned project.
IV. AVAILABILITY OF IHCP PORTAL
The IHCP Portal shall be made available fifteen (15) days after publication of this Circular in any newspaper of general circulation and deposited thereafter with the National Administrative Register at the University of the Philippines Law Center.
All other provisions of previous issuances that are inconsistent with any provision of this Circular are hereby repealed/modified or amended accordingly.
Please be guided accordingly.
Adopted: 17 January 2012
(SGD.)DR. EDUARDO P. BANZON
President and CEO
[*] Text Available at Office of the National Administrative Register, U.P. Law Complex, Diliman, Quezon City.
To strengthen PhilHealth’s partnership with accredited Institutional Health Care Providers (IHCPs) through access to a web-based Portal for on-line verification of membership status of Sponsored Program (SP) Members under the National Household Targeting System for Poverty Reduction (NHTS-PR) during benefits availment.
II. THE IHCP PORTAL
A. Sponsored Members (NHTS-PR) eligibility verification and IHCP profile
The IHCP portal is established to provide a link between accredited institutional health care providers and PhilHealth through an on-line connection that shall ensure verification of the following eligibility information of Sponsored Members under NHTS-PR for purposes of availment of PhilHealth benefits:
1. PhilHealth Identification number (PIN)
2. Member’s name and date of birth
3. List of declared dependent/s
In addition to the abovementioned features and as part of the IHCP portal enhancement process, significant modules (e.g., e-logbook, benchbook, MMHR) shall eventually be incorporated to the said portal in order to expand the efficiency of on-line transaction between the participating accredited IHCPs and PhilHealth.
B. Requirements
Accessibility/Linkage to IHCP portal is open to all qualified accredited IHCPs. Prior to registration proper, IHCPs must have the following requirements:
1. Information Technology (IT) hardware:1.1. Computer2. Internet connection
1.2 Printer
C. Participation of the HCPs
The following are the steps in IHCP portal registration:
1. IHCPs may visit the PhilHealth official website (www.philhealth.gov.ph) in order to access the PhilHealth Online Access Form (POAF, No. 002) module for the downloading of the application form and its attached certificate of non-disclosure agreement;
2. Accomplished POAF and certificate of non-disclosure agreement shall be submitted to Health Care Delivery and Management Division of PhilHealth regional Office for proper verification and evaluation of the said forms (see attached Annex A[*] and B[*]: sample of properly accomplished forms);
3. Once approved and evaluated by PhilHealth, qualified IHCP’s shall be visited for the installation of IHCP portal and shall be given orientation on its application; and the facility is ready for verification.
D. Generation of Reference Number
1. Eligibility verification using the IHCP portal shall be made at the facility level prior to the availment of PhilHealth benefits by the sponsored members and their dependents under NHTS-PR.
2. If the SP member under NHTS-PR has been verified through this portal, a reference Number (RN) will be generated based on the following information (see attached Annex C[*]: sample of reference number):
1.1 Accreditation Number
1.2 Name of hospital
1.3 Name of patient
1.4 Confinement period
1.5 Name of member
1.6 Date of coverage
1.7 Account name of computer operator that accessed the IHCPP
3. The generated RN shall be attached to the claims replacing the MDR and other secondary documents like birth certificate, marriage contract and the like.
4. Properly accomplished PhilHealth Claim Form 1 is still required for claims submission.
III. PARTICIPATION IN E-CLAIMS PROJECT
IHCPs that are currently enrolled in the e-claims project are no longer required to apply for installation of IHCP portal because eligibility verification of Sponsored Program Members under NHTS-PR is already covered by the abovementioned project.
IV. AVAILABILITY OF IHCP PORTAL
The IHCP Portal shall be made available fifteen (15) days after publication of this Circular in any newspaper of general circulation and deposited thereafter with the National Administrative Register at the University of the Philippines Law Center.
All other provisions of previous issuances that are inconsistent with any provision of this Circular are hereby repealed/modified or amended accordingly.
Please be guided accordingly.
Adopted: 17 January 2012
President and CEO
[*] Text Available at Office of the National Administrative Register, U.P. Law Complex, Diliman, Quezon City.