PhilHealth Requires Accredited Healthcare Providers to Submit SOA on All Case Rate Claims for Reimbursements

The Philippine Health Insurance Corporation (PhilHealth) is reminding all accredited healthcare providers nationwide about its latest policy requiring submission of Statement of Accounts or SOA for applications of claims for reimbursements on all case rates (ACR).

“Well, we require yung mga healthcare providers natin na dapat pag nag-claim sila sa atin, dapat i-attach yung Statement of Accounts (SOA) bilang isa sa mga requirements namin para sila ay mabayaran,” Atty. Alexander A. Padilla, PhilHealth president and CEO, said during the quarterly “Kapihan with the CEO” at the PhilHealth Central Office in Pasig City on Monday.

He said that the failure of healthcare providers to attach SOA as an essential requirement for the reimbursement of claims may delay the process because they will have to return it to the sender or healthcare provider to comply with the need of completing the needed entries.

Padilla said the new policy is contained in PhilHealth Circular No. 2016-0005 he signed last March 28, 2016.

SOA is the actual total hospital charges minus the PhilHealth benefit for the Health Care Institution (HCI) fee.

Part III, Item A of Claim Form 2 (Certification of Consumption of Benefits and Consent to Access Patient Records must be consistent with that of the SOA of the patient.

It should be duly signed by the member and his authorized representative (with printed name, relationship to member and contact number) confirming or concurring with the statements therein relative to PhilHealth deduction.

The signatory in the SOA must be the same person as the signatory of PhilHealth Claim Form 1 under Part III (member certification).

In case the signatory in Claim Form 1 is different from the signatory in the SOA, information for authorized representative (name, relationship to member, contact number) should be indicated in the SOA.

The SOA should have the signature over printed name and position of the accountant or billing clerk.

The original or certified true copy of the SOA shall be submitted together with the PhilHealth claim forms for claims application for ACR.

The SOA shall not be required for claims application for the following: TB DOTS, Maternity Care Package, Peritoneal Dialysis Case Rates, Malaria, Outpatient HIV/AIDS Treatment Package, Animal Bite Treatment Package, and Newborn Package (in non-hospital facilities).

Atty. Padilla said the new policy came after a review of all case rates in terms of enhancing or improving the policy of PhilHealth. (PNA) SCS/LSJ