PhilHealth Issues New Policy on Claims for 3 Diseases

The Philippine Health Insurance Corp. (PhilHealth) no longer requires the length of stay in hospital as basis for reimbursing claims for pneumonia, acute gastroenteritis, and urinary tract infection (UTI).

Circular No. 2017-0028, signed by Dr. Celestina dela Serna, PhilHealth interim officer-in-charge president and CEO, stated that such claims will instead be subjected to pre-payment medical review, or the review of claims to determine admissibility prior to payment.

It said the policy also aims to encourage health care institutions that have the resources and capability to file appropriate claims when patients are managed in critical care when complications arise.

“This policy shall cover inpatient claims for pneumonia, acute gastroenteritis, UTI and other conditions of eligible PhilHealth members and their qualified dependents in all PhilHealth-accredited health care institutions,” the circular noted.

It also said all claims for the three illnesses require the submission of the patient’s certified true copy of complete clinical chart.

In the past, cases of pneumonia and UTI had a length-of-stay requirement of four days, and acute gastroenteritis, three days.

The circular was issued last September 25. (PhilHealth)