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PhilHealth Claims Portal Software

PhilHealth E-Claims Portal

Overview:
Philippine Health Insurance Corporation (PhilHealth) is committed to ensuring ease of availment at the point of care for all its beneficiaries. In lieu with this, in 2011, PHIC launched the eClaims Project through PhilHealth Circular No.14 and Office Order No. 69 which broadly aims to streamline key processes such as eligibility check, claims submission, verification, and payment in order to serve both members and partner providers better.

By accrediting your hospital or organization for PHIC E-Claims, you can directly file for claims and unite with PhilHealth’s vision of a more efficient, enhanced and effective claims processing. We will help  you with the  processing. This is not the same with the e-claims module inside our HIS Phase 1.

  • E-Claims in Phase 1: PhilHealth claims are done via a middle-ware and has a payment per transaction (around P20sh)
  • This E-claims in Phase 3: No more middle-ware and claims are without per-transaction costs. You hospital herself is accredited.

PhilHealth E-Claims Portal (PHIC) is an integrative system that is made for citizens of all ages to assist them throughout their PhilHealth E-Claims. With these functions, namely Application, Outright Deductions, Patient List, and PHIC Transmittal, the PhilHealth E-Claims Portal is the definitive answer to PhilHealth members who are longing for a better and faster service in acquiring these claims.

  • Faster and easier claims due to automation and reduction of encoding / manual process
  • Added value for patients due to faster and more convenient processing
  • More savings in the long run by eliminating per-transaction costs
  • If there’s an existing system, scoping is needed for assessment of integration to database

Application

  • Add New Application
  • Filter Application Dates
  • Search Individual Application
  • Edit Existing Application
  • Approve Application
  • Void Application
  • Reject Application
  • View and Print Claim Signature Form (CSF)
  • View and Print Claim Form (CF3)
  • View and Print Claim Form 4 (CF4)

Outright Deductions

  • Add New Outright Deductions
  • Filter Outright Deduction Dates
  • Search Individual Outright Deduction
  • View Individual Outright Deductions
      • View Computation Table
      • View Diagnosis/Case Rates
      • View Physicians and Doctors
      • View Items and Services
      • View Rooms and Beds
      • View Special Consideration
    • Void Outright Deductions

Patient List

  • Filter Patient List Date
  • Search Individual Patient
  • Filter Patient Type and Patient Status
  • Select Department
  • View Patient Records
    • Generate Statement of Account (SOA) – Default
    • General Statement of Account (SOA) – Default without Credit Notes
    • Generate Statement of Account (SOA) – Itemized Payments
    • Generate Statement of Account (SOA) Itemized Payments without Credit Notes
    • Generate SOA Summary – PhilHealth
    • Generate SOA Itemized – Default
    • Generate SOA Itemized – Discounted
    • Generate SOA Itemized – Date
  • View patient Diagnosis
  • View ICD-10 Diagnosis
    • Select ICD-10 Diagnosis
    • View Surgical Procedures
    • Select Surgical Procedures
  • Add Professional/Doctor Fee
  • View Patient Doctor(s)

PHIC Transmittal

  • Filter Transmittal Date
  • Search Individual Transmittal
  • Filter Transmittal by Patient Type
  • Add NEw Transmittal
  • Edit Existing Transmittal
  • Remove Patient From Transmittal
  • View Individual Transmittal
  • Print Transmittal
  • View Transmittal List
    • Void Transmittal
    • Post Transmittal
  • Payment Allocation
    • Filter Payment List per O.R. Date Range
    • Search Payment per O.R.
    • Add Payment Allocation

Requirements

Pre-Qualification Requirements from Client

  • Letter of Intent
  • On-site validation (Annex H)
    • Building location
    • Secured access
    • Air conditioning
    • Power supply
    • Network security system
    • Server and storage facilities
    • Off-site server (backup)
    • Data connections
  • Two sets of Hard copies and soft copy
    • HITP Data Record (Annex B- PHILHEALTH CIRCULAR No. 038 s. 2012) https://www.philhealth.gov.ph/circulars/2012/circ38_2012.pdf
    • Proof of Payment (P 10k)
    • Company portfolio (nature of business, ownership and location, org chart, key people, the board of directors, TIN)
    • Notarized certification of an ongoing completed IT systems projects contracts with govt and private IHCP
    • SEC certificate
    • Business Permit
    • Audited FS
    • Proof of paid-up capital (not less than P500k capitalization)
    • Business Agreement (Annex C- PHILHEALTH CIRCULAR No. 038 s. 2012) https://www.philhealth.gov.ph/circulars/2012/circ38_2012.pdf

Inquire for a demo now.

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