Project Reach Out Stakeholder's Forum is held quarterly to provide updates for accredited health care providers in the Region.
|South Cotabato Provincial Hospital representative, Miss Rona E. Chatto clarified issues on possible fake membership and dependents declared by the patients during admissions in their facility.|
This forum according to PhilHealth XII Field Operations Division Chief, Engr. Eugenio Donatos is on a credit side because it deals with policies in terms of paying hospitals contrary to the marketing forum activities which deal with the debit side.
“I do understand that each one of you as our partner in implementing the National Health Insurance Program have your unique number and have your own story. Our members have also their unique numbers and they too have their stories. Ours … is a promise to make that story fulfilling and promising for them. I hope you too, would share the same story by delivering our promises that is fulfilling for them. Thank you..." Donatos said.
During the question and answer portion, Benefits Administration Section Head Dr. Henry F. Manzares stressed to write only the correct information on the Statement of Account, Form 2 and other required documents for claims processing. “We are paying for the services you are giving to our members. Please be consistent with figures in all your attachments. Write only what is true. Kindly include contact numbers of the members/ patients themselves. It is mandatory.”
Special Investigator II Sharon Bona from the Legal Services Office pointed this out when one of the clients asked on how to deal with patients telling a lie about their identity, their dependent spouse and dependent children.
She said that only those who fabricate or provide false information are liable to any violation against the policy.
“Hospitals as partners in implementing the program have their duties in protecting our fund by checking it out if the members they are admitting are legitimate or not,” Donatos added.
Per PhilHealth’s Implementing Rules and Regulations, borrowed identity and fake membership is a patent form of fraudulent activity and considered unlawful in the benefit availment process.
Hospitals with Philhealth Customer Assistance, Relations and Empowerment Staff or P CARES on the other hand are mandated to provide said personnel with work stations and logistics.
“These nurses have their duties and responsibilities that help our members understand their benefits and benefit availment process. We will be deploying them per month on identified hospitals and no longer per quarter. Please accommodate them well,” PhilHealth XII CARES Supervisor Raffy B. Elizares said.
As employers, Senior Social Insurance Officer, Joy S. Lizada reminded the participants to adopt the new EPRS or electronic premium remitting system and secure SPA or statement of premium accounts in settling their obligations to PhilHealth effective July this year.
In terms of claims disbursement Cashiering Unit Head, Ma. Luna Soriano stressed that PhilHealth strictly impose the “no OR, no check” policy. “Those who are sending representatives please take note that SPA or Special Power of Attorney remains a mandatory requirement. SPA is only valid for one year, unless revoked. Kindly renew it every year to avoid inconvenience in claiming your checks,” she said.
Other issues and concerns were answered thoroughly by the panelists and in conclusion, Health Care Delivery and Management Division Chief, Dr. Edson F. Pama thanked the participants for coming. (hanah g. naanep)
|PhilHealth XII Project Reach Out Team Members: |
L-R: (standing) Victor Benedict V. de Jesus, Roberto P. Ontanillas, (seated) Nancy A. Apoldo, Melody Mae D. Gatmaitan and Dr. Rizalino C. Urbano