The PhilHealth section of Asian Hospital and Medical Center provides accurate computation of benefits and timely rendering of service to qualified PhilHealth members in the hospital. It provides excellent customer service in handling basic queries to our clients and patients during their hospital visit, assesses all Philhealth documents submitted by the patients/relatives, and computes the Philhealth benefits of both in and outpatient cases.
To maintain quality improvement and patient safety, AHMC follows process and procedure for PhilHealth benefit application:
- Accomplished original copy of claim forms and supporting documents must be submitted to PhilHealth Office.
- Validity if the physician is PhilHealth accredited will be done by the staff. Lapsed accreditation claims will not be compensable.
- Data and Claim Form 1 will be reviewed by the staff.
- Data and Claim Form 2 will be reviewed by the staff.
- Diagnoses and procedures written on the Claim Form 2 will be checked by the staff if coverable by PhilHealth.
- The staff must identify the correct International Classification of Diseases (ICD) 10 code of the illness to help them evaluate if the case will be covered under Case Rate.
- The staff shall compute for the allowable benefit and write down the patient’s details and computation on the Credit Memo (CM) to be forwarded to Billing Department for the purpose of benefit deduction on the hospital bill.
- The staff shall scan the CM and give the green copy to the Billing Section.
- For non-compensable cases, PhilHealth staff shall give a non-compensable case form to billing section stating the reason and advise the biller to collect the PhilHealth portion from the patient or charge to insurance whichever is applicable.
- For expired patient admitted less than 24hrs., Claim Form 3 shall be accomplished by patient and attending physician