NO U · 2020. 12. 28. · Assisted Registration LGU/ OSCA Eligible Beneficiary submits the...

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-- An nex A: Registra ti on to a Phii Hea lth Konsulta Provider •;._.,;, il'.c . ... - _ ... :. ' !L·•, ">: : . f. ' - , C ·•- ., Lii!;.t.; •• . J: ·-- '!it ... ... , .._ .. ,;.,J- .. :l " :l5 :!!> w Ci. .s .t: ";;; " :X:" e O o,. h 0 ;,:: 5 .. "' - => EO lf!l i; "J, . " -;; " .. = ::J .t: a.£ Update Member Data Record (MDRI through filling-out the Member . m ... Registration Form NO I Log-In to the Member Portal ot Member Online Recistroton' through PhliHealth reSister 1 ,, Screen shot and/or print t he confirmati on inessage'as proof that have been al reaqy, I r--' to a Phlltfelllth . ' FiU'<lut the . Phil Health Konsulta Registratl. on Form (see Annex . Cl ,., I' 1 Register t he eligible beneficiary to their preferred Phii Heajth Assisted r:\'&\Stratil' .n? ·Yes facility .through Electronic Premium . 1 , jEPf!S) '"""" li No No No Phi1Heal LHI O? No '" YU I YH Register the eligible beneficiary to 'preferred PhiiHeakh : Register the eligible benefici ary to iheir u preferred Phil Health Konsq!!ll facility !\'rough My · Ph,U I'e!Uti PorUI. , , 1 Register tile eligible. their ... prderred PhiiHealt.h .Konsutia fadlitV'through -.a , n Generate the confirmation receipt with QR code and pr1nt or a dfgital l ma_ge of1he QR ' coae through bepeficiary's , o'rfill thi! ' ' conflrf!latl'on slip {see Annex Cl and release it to U Generate the confirmation receipt with QR code and print or take a digital image of the oR code.t hrough " ·' eamera.6r flU ouHhe copfirmatlon slip {see Annex q and, it ' !? thi benoflciary R Generate the confi rmat ion receipt with QR cod . e and prinF oll;lke a digiblimage of the QR code ' , camera Offill out. the . slip (see Annex q and it 10 the beneficiary r Generate the confirmation receipt with QR code and print or take a ' digital image ofthe QR coqe through beneficiary's da(!lera or fill out the confirmation sliP Annex ' ct ami release It!\) "t:J t...L.. .;!!. :i l.lJ r ('(t Generate the confirmation g § iii I"- (L 0 Register the e ligible receipt Wfth QR code and brlnt c:.,, ". ""J . Q I' benefidary" to their ' or take a digital image' of the QR u- VJ Y •s •: w "' £. : g . A' I) ____., beneficiary's 'iii 8 a.. "'4.. ...._ Koosulta faciity camera or fill out the ;, a.·- 2 ' .. ;.. 1 conrlrrhatlon sqp C) f.: .fi releaselt,to th,e beneficiary < I ' L __ . __ _ . .. "- 8- .s= Q,I 0 ilitl - ' ' Answer the securily que>tfons f-.. .-- Flll-<>ut the Phil Health Konsulta transfer request fQrm (see F. ormA) ........ I In case of I, non- renewal or suspension of . accred itation or ciosureof the PhiiHealth Konsu[ta 'facili ty, ln(orm the cbnCI!rned ·• beneficiaries factliclte transfer tb aootl]er accredited J<oruulu ficlllty • Registerihe eliglbie beneficlary'to their H the prefe/ied P.hiiHealth confirmation details I J<Oflsulta facility through to the registered '' C SMS , · beneficJ..arles Page 1 of 2 of Annex A

Transcript of NO U · 2020. 12. 28. · Assisted Registration LGU/ OSCA Eligible Beneficiary submits the...

  • --Annex A: Regist ration to a PhiiHealth Konsulta Provider •;._.,;, ~;:~~~:.:;~-~;~ ;;.rJ~:t:.:::;K·~~ ·':;:;~~;:~:E.~~~::··:;~·:.;. ·~ 'c,~ il'.c ~ "-:~J{wf:~~r~~i\ir~ . ~,~ ... ~ ~ - _ hfl,~r·r:r....-~ ~+~}tr,;~ ·--~;~~~~:--

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    Update Member Data Record (MDRI through

    filling-out the PhliHealt~ Member. m ... Registration Form

    (P~RF) '·

    NO

    I Log-In to the Member

    Portal ot Member Online Recistroton' through

    PhliHealth ~ebsil>! ~od reSister

    1 ,, Screen shot and/or print the confirmation inessage'as proof

    that y~u have been al reaqy, I r--'

  • FormA .. I Philhcalth Konsulta Transfer Registration Form To be filled-ou t by the Beneficiary Name: ___________ _ PIN: ___________ _

    Member: __ Dependent: __ (please check) Contact No:-----Email Address (if applicable): - - -----

    Name of previous PhilHealth Konsulta Facility: ---------- -Preferred PhilHealth Konsulta Facility and Address (Mumcipali

  • I Annex B I

    PhilHealth

    I

  • Table of Contents Rationale ........................ ...................................... ......... ............................... .... ...... : ..... ........................ .......................... ...... . 3

    O bjective ............ ........... .............. .... ... .......... ............. ................ ... .... .. ................. ......................... .............................. .......... 3

    Scope ........... ................ .. .... ......... ................... ...................................... ................ ................. ................................ ................. 3

    Policy Staten1ent ............................................................................ .................... ................................................................ .. 3

    Guidelines ............... ...................................... ............... ................. .. ....... .................................. ........................... .................. 4

    Procedures ................................................. ..................... ....................................... ..................... ............. .............. ............... 5

    --------AAT

  • ,.. I

    i I

    Rationale

    The Universal Health Care Law aims to "ensure that all Filipinos are guaranteed equitable access to quality and affordable health care goods and services and protected against financial risk." To meet the goal of progressively realizing universal health care in the country, PhilHealth adopted a comprehensive approach to delivering primary care through the development of the PhilHealth Konsultasyong Sulit at Tama (Konsulta) Package.

    Joint Administrative O rder N~~a~.W.aelines-en-the-R-egist::ration of Filipi:.t""ro""'s~rt7o..--------

    a Primary Care Provider" provides that PhilHealth shall .issue specific guidelines, infonnation, and manual of procedures related to registration of Filipinos to a primary care provider. Likewise, Section V.4.f..i. of the Implementing Guidelines for the PhilHealth Konsulta Package states that a manual of procedure shall provide the details on the process for assisted registration. This manual is created in compliance with the provision of the said issuances.

    Objective

    This PhilHealth Konsulta Assisted Registration Manual aims to achieve the following objectives:

    1. Outline the process for assisted registration through different PhilHealth authorized third party agencies/ organizations;

    2. Capacitate third party agencies/ organizations on the process of assisted registration of eligible beneficiaries to a PhilHealth Konsulta Provider; and,

    3. Provide eligible beneficiaries with a guide on the process of assisted registration through authorized third party agencies/ organizations.

    Scope

    The PhilHealth K onsulta Assisted Registration Manual provides guidelines and outlines the procedures for assisted registration facilitated by third party agencies/ organizations authorized by the Corporation.

    The process for authorizing third party agencies and organizations shall be issued on a separate

    manuaL

    Policy Statetnent

    In compliance with the Universal Health Care Act, and all other applicable laws and issuances, PhilHealth is committed to expand the primary care benefit to cover all Filipinos. T he Corporation shall make necessary steps and procedures to ensure the realization of this goal, among them shall be authorizing third party agencies and organization to facilitate the regs · n of eligible beneficiaries to an accredited PhilHealth Konsulta Prmrider.

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    ~8~ Page 3 of 11 of Annex H

  • Guidelines

    1. Eligible beneficiaries including but not limited to minors, perso.ns with disabilities (P\VDs) and those with no internet access or have difficulty using and accessing information technology (IT) can opt for assisted registration.

    The following are the PhilHealth authorized third party agencies/ organizations eligible beneficiaries may go to for assisted registration:

    a. PhilHealth Konsulta Provider b. Local Government Units (for residents of the LGU) c. Office for Senior Citizens Affairs (OSCA) (for senior citizens in the LGU) d. Employers (for government/ private sector employed beneficiaries)

    2. All Phill-Iealth authorized third-party agencies/ organizations shall be responsible for ensuring the rights of the eligible beneficiary, including but not limited to the right to choice of a primary care provider, nondiscrimination, and privacy.

    3. All eligible beneficiaries and third party agencies/ organizations shall follow the assisted registration procedures set by the Corporation through this Manual.

    Page 4 of 11 o f Annex B

  • Key Steps Office/ person Details Responsible

    Assisted Registration Social Worker of the E ligible Beneficiary submits the filled-out PhilHealth through the PhilHealth PhilHealth Konsulta Konsulta Registration Form. Konsulta Provider I Provider

    1. Receive the Registration Form

    2. Check form completeness a. Name and P IN number provided l:>o- -Geru-aet-rtumher-provided

    (In cases where the eligible beneficiary has no mobile munber, ask for alternative contact details

    c. e.g. email address/ next of kin's mobile number) Email address provided (if applicable)

    d. Name of preferred PhilHealth Konsulta Facilities provided (1 '1 to 3'J Choices)

    e. Address of preferred PhilHealth Konsulta Facility provided

    f. Form is duly signed

    3. If all fields are properly filled out: 3.1. Register the eligible beneficiary to their preferred

    PhilHealth Konsulta Facility through POS-URS If no t properly filled out: 3.2. Provideinstruction to facilitate form completion 3.3. Re-check form after compliance of the eligible

    beneficiary

    4. Provide Registration Confirmation Receipt/ Slip 4.1 Generate the confirmation receipt with QR code

    4.1.1 Ptmt receipt and issue O R

    2 4.1 .2 Ask beneficiary to take digital copy through phone camera . ' -..:.. O R ¢0 .....:::::. 4.2. Fill-out the registration confirmation slip and ~ . ....... 1ssue

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    5. For generated confumation slip with QR Code !-~a_ 0 (/)0 5.1 Eligible beneficiary receives confirmation slip

  • Assisted Registration through the LGU/ OSC.A

    Eligible

    Benefklary

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    Eligible

    Benefidarv

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    l'ai(C 7 of 11 oft\ nncx B

  • Key Steps Office/ person Details Responsible

    Assisted Registration LGU/ OSCA Eligible Beneficiary submits the filled-out PhilHealth through d1e LGU / OSCA 2

    Konsulta Registration Form.

    1. Receive the Registration Form

    2. Check form completeness a. Name and PIN number provided L r b · , u. vOOtact UUlll el p t OVlUt:U

    (In cases where the eligible beneficiary has no mobile number, ask for alternative contact details e.g. email address/ next of kin's mobile number)

    c. Email ad~ress provided (if applicable) d. Name ofpreferred PhilHealth Konsulta Facilities

    provided (1" to 3".J Choices) e. Address of preferred P hilHealth K.onsulta Facility

    provided f. Form is duly signed

    3. If all fields are properly filled out: 3.1. Register the eligible beneficiary to their preferred

    PhilHealth Konsulta Facility d11ough My PhilHealth Portal

    If not properly filled out: :1.2. Provide instmcti.on to facilitate form completion 3.3. Re-check form after compliance of the eligible

    beneficiary

    4. Provide Registration Confirmation Receipt/ Slip 4.1 Generate the confmnation receipt with QR code

    4.1.1 Print receipt and issue OR

    g 4.1.2 Ask beneficiary to take digital copy through phone camera ,--~

    OR 4.2. Fill-out '

    1the registration confumation slip and

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    (.'( w UJ.>- "l"-(I'J 5. For generated confirmation slip with QR Code 1- · ll.. 0

    I (/jQ 5.1 E ligible beneficiary receives confirmation slip with •

    ~ (.)~ QRCodeOR ._.-;__ ~ 5.2 Eligible beneficiary takes a digital copy through ~ phone camera I

    u a 6. For filled-out registration confirmation slip; E ligible

    beneficiary receives the slip

    2 Eligible beneficiary shall first update their Member Data Record (MDR) and shall have their Phil Health Individual Number (PIN) prior to the assisted registration.

    Page 8 o f 11 of 1\nnex H

  • "\.ssistcd Registration through Employer

    Eligible

    Benef iciary

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    EHgible

    Beneficiary

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    Page 9 of 11 of Annex K

  • Key Steps Office/ person Details Responsible

    Assisted Registration Employer E ligible Beneficiary submits the filled-out Ph.ilHealth through the Employer 1 Konsulta Registration Form.

    1. Receive the Registration Form

    2. Check form completeness a. N ame and PIN number provided b. Contact number provided

    (In cases where the eligible beneficiary has no mobile number, ask for alternative contact details e.g. email address/ next of kin's mobile number)

    c. Email address provided (if applicable) d. Name of preferred Ph.ilHealth Konsulta Facilities

    provided (1 '1 to 3'J Choices) e. Address of preferred PhilHealth Konsulta Facility

    provided f. Form is duly signed

    3. If all fields are properly filled out: 3.1. Register the eligible beneficiary to their preferred

    PhilHealth-Konsulta Facility through EPRS If not properly filled out: 3.2. Pr,wide instruction to facilitate form completion 3.3. Re-check form after compliance of the eligible

    beneficiary

    4. Provide Registration Confirmation Receipt/ Slip

    ~ 4.1 Generate the conf1tmation receipt with QR code

    4.1.1 Print receipt and issue OR

    i 4.1.2 Ask beneficiary to take digital copy through I phone camera I "" OR Q! I ......... 4.2. Fill-out the registration confmnation slip and issue

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    I 1-· l.L a 5. For generated confirmation slip ·with QR Code !

    VJ O ~ 5.1 E ligible beneficiary receives confirmation slip with !

  • Directorv .;

    (List of Authorized 3'd party agencies/ organizations, once available)

    .J

    Page 11 of 11 of r\nncx H

  • Annex C

    .... ~ Philhealth Konsulta Registration Form

    To be filled-out by the Beneficiary Name: _________ __ _ PIN: ___ ___ ____ _

    Member: __ Dependent: __ (please check) Contact No: ____ _ Email Address (if applicable): - - --- --

    Name of previous PhiiHealth Konsulta Facili ty: -----------Preferred Phi!Health Konsulta Facility and Address (Municop>lity/ Tou-n/ Cny/ Provmce): 1" choice:-- ------ -----------:2"d choice:----------- --------3"' choice:-- --- --- ---------- -

    PhilHcalth's Copy ~---- ---- --- - - ----- ---------------------------- ----------------------" I PhilHealth Konsulta Registration Confirmation Slip To be filled-out by the Authorized personnel

    Registration No.: _ ___ _ _____ _ Date registered: _ ___ _ _____ _ Name: ___________ _ _ _ PIN: ____________ _

    Phi!Health Konsulta Facility: ______ ___ _ _ _ Phi!Health Konsulta Facility Address: __________ _

    (Signature over printed name of Authorized Personnel)

    (ro be printed at the back) Instructions:

    Beneficiary's Copy

    1. All informacion should be written in UPPERCASE/CAPITAL LETTERS.

    2. All fields are mandatory. 3. If the beneficiary is dependent, use the dependent PIN. 4. If the beneficiary is below 21 years old , the signatory should be the

    parent/ guardian.

  • ANNEX D: PhilHealth Konsulta Benefit T ab le

    ..-\. P ri mary Care Sen·iccs - flrs t-conract, compreh ensive. continuing and coordinatiYe care to

    beneficia ries inclmli.ng but not li.mited to:

    1. Consulrarion and case managcmen t for any conditions, including individual health education,

    that can be managed by a Primary Care Physician and team as determined by the legal scope of

    pra ctice

    2. Provision of preventiYe healrh services as listed in .r\ nnex E

    3. .·\ssisring eligible beneficiaries in accessing services in subcontracLed or partner facilities

    -1. Referral to specialt:· and higher levels of care

    ------~B.t..~s.)j· ewl.

  • ANNEX E : List of P Health Services based on Lifestage Guarantee s

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    Age

    0 - 12 months

    >1 - 4 years old

    5 - 9 years old

    10 - 19 years old

    20-39 years old

    40-49 years old

    1- £.L Q 1-1-----------t----t U'JO

  • Annex F: PbilHealrb ~onsulra Benefit 1hailmcor Process

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    .. ~ Request for Authorization Transaction Code CRATCl

    To be filled-out by the Beneficiary Name: ____________ _ PIN: ___________ _

    Member: __ Dependent: _ _ (please check) Date of Appointment _____ _

    (Signature over printed name)

    PhilHealtb's Copy ~------- ------- ------------------------------------------------.

    To be filled-out by the Phili-Iealth personnel

    ATC: ___ __ _

    (Signature over printed name of Authorized Personnel)

    Beneficiary's Copy

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    '-~··---···--- . --. _.,._

    Page 2 of 2 of Annex F

  • ANNEX G: Electronic Konsulta Availment Slip ( eKAS)

    E lectronic Konsulta Availment Slip (eKAS)- proof of availment of services by the eligible beneficiary. This will be generated by the Phill-lealth Konsulta facility for every patient encounter and to be submitted to Phill-Iealth.

    ELECTRONIC KONSULTAAVAILMENT SLIP (e KAS)

    HCI Name: Case No.: HCI Accreditation No. Transaction No:

    ,-atfenti'-+arrre-(r angamn ng pasyemer Age (Edad): Contact No. PIN (PhilHealth Identification Number): Membership Category: Membership type: ___ Member Dependent Authorization Transaction Code (ATC):

    To be filled out by the facility (pupunuan ng pasilidad) .. ' ,. ,, . Performed by

    ::!_ Performed Date performed

    (Ginawa ni)

    (nagawa) (Initial/Signature of Health Konsulta Services

    X Not performed (Iletsa kung kelan

    care Provider/ technician)

    (hindi nagawa) ginawa)

    (Initial o Lagda ng Health care Provider/technician)

    History and physical examination (vitals, anthropometries)

    CBC

    To be filled o ut by the patient (pupunuan ng pasyente) .

    Have you received the above-mentioned essential services? - Yes - No (Natanggap mo ba ang mga essential services na nabanggit?)

    How satisfied are you with the services provided? o© o© (Gaano ka nasiyahan sa natanggap mong serbisyo?) D For your comment, suggestion or complaint:

    (Para sa iyong komento, mungkahi o reklamo)

    Under the penalty of law, I attest that the information I provided in this slip are true and accurate. (Sa ilalim ng batas, p inarutunayan ko na ang impormasyong ibinigay ko ay to too at tama)

    Next Consultation Date: Signature over printed name of patient (Petsa ng susunod na konsultasyon) (Lagda sa nakalimbag na pangalan ng pasyente)

    Note:

    Accomplished form shall be submitted to PhilHealth. (Ang kumplctong form ay dapal isumite sa PhilHealth)

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    P~o-p 1 nf 2 nf AnnP\' G

  • ANNEX G: Electronic Prescription Slip (ePresS)

    Electronic Prescription Slip (ePresS) - proof of availment of medicines by the eligible beneficiary. This will be generated by the PhilHealth Konsulta facility for every patient encounter and to be submitted to PhilHealth.

    E LECTRONIC PRESCRIPTION SLIP (ePresS)

    I ICI Name:----------------- Case No.:-- -------------HCI Accreditation No.--------------Transaction No:-------------

    FatJent Name (pangalan ng pasycntc): _____________ Age (cdad): _ ___ Contact No.-----------PIN (PhilHealth Identification Number): Membership Category: Membership type: _Member:_ Dependent

    To be filled out by the faCility (pupunuan ng pasilidad)

    Category (Kategorya)

    Antibacterial

    Medicine Strength/Form/

    Volume (Gamot/ Anyo/Da

    mi)

    Amoxicillin 500 mg Capsule

    Quantity (bilang)

    Name of the Prescribing Physician

    (Pangalan ng nagresetang doktor)

    Antipyretic Paracetamol

    500 mg Tablet Signature over printed name

    License#:------

    To be filled out by the patient (pupunuan ng pasyente)

    Did you receive the above mentioned medicines? _ Yes _No (Natanggap mo ba ang mga gamot na nabanggit?)

    Are you satisfied with the medicines you received? (Nasiyahan ka ba sa mga gamot na natanggap mo?)

    For your comment, suggestion or complaint: (Para sa iyong komento, mungkahi o reklamo)

    '

    :!... Dispensed (naibigay) X Not

    dispensed (hindi

    naibigay)

    Date dispensed

    (Pets a kung kelan naibigay)

    Name of the Dispensing Personnel

    (Pangalan ng nagbigay)

    Signature over printed name Name of Dispensing Facility:

    Under the penalty of law, I attest that the information l provided in this slip are true and accurate. (Sa ilalim ng b atas, pinatutunayan ko na ang impormasyong ibinigay ko ay totoo at tama)

    Signature over printed name of patient (Lagda sa nakalirnbag na pangalan ng pasycnte)

    Note: Accomplished form shall be submitted to Phi!Health. (Ang kumpletong form ay dapat isumite sa Phi!Hcalth)

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    Next Dispensing Date: ---------(Petsa ng susunod na bigay ng gamot)

    P~o-p 2 ()f 2 ()f A n nPx !.

  • ~----·· -· .

    ANNEX H: Approved Benefit Paym ent and Balance Billing/Co-payment Schedule

    1. The maximum per capita rate amount for Konsulta shall be at Php750.00 and PhpSOO.OO for

    private and public facilities, respectively.

    a. The Konsul ta provider will receive 40% of this amount based on the no. of registered with first patient encounter.

    b. The Konsulta provider will receive 60% of this amount based on the no. of

    registered with first patient encounter as of December that year and achieved performance targets at the end of the year.

    2. First tranche (40%)

    a. The Konsulta provider will receive a prorated portion of PhP300 (private)/PhP200 (public) based on the no. of registered eligible beneficiaries with first patient encounter (see Annex J, "List of Minimum Personal Information for the First Patient Encounter")

    b. Monthly encountered data records shall be submitted to PhilHealth every 15th calendar day of the immediately succeeding month. (see Annex I, Submission of Reports) .

    c. The Monthly computed capitation amount based on submitted encountered data records will be released within 30 days. from date of submission

    d. Sample computation:

    Table 1: Sample computation for the First Tranche for Public facility

    M onth Number Number of Calculation Sample individuals registered with Capitation reg istered encountered data per month record per month

    Jan 2,000 1,500 1,500 * 200 *(12/12) 300,000.00

    Feb 2,000 2,000 2,000 * 200 * (11/ 12) 366,666.67

    Mar 1,500 500 500 * 200 * (10/12) 83,333.33

    Apr 3,500 3,000 3,000* 200 * (9/12) 450,000.00

    M~ 2,000 600 600 * 200 * (8/ 12) 80,000.00

    Jun 1,000 1,500 1,500 * 200 * (7 / 12) 175,000.00

    Jul 500 1,000 1,000 * 200 * (6/ 12) 100,000.00

    Aug 1,500 750 750 * 200 * (5/12) 62,500.00

    Sep 2,500 1,300 1,300 * 200 * (4/ 12) 86,666.67

    Oct 1,000 800 800 * 200 * (3/12) 40,000.00

    Nov 1,500 1,000 1,000 * 200 * (2/12) 33,333.33

    Dec 1,000 900 900 * 200 * (1/ 12) 15,000.00

    Total 20,000 14,850 1,792,500.00

    Page 1 of 4 of Annex H

  • Table 2: Sample computation for the First Tranche for Private facility

    Month Number Number of Calculation Sample individuals regis te red with Capitation1

    registered encountered data per month record per month

    Jan 2,000 1,500 1,500 * 300 *(12/12) 450,000.00

    Feb 2,000 2,000 2,000 * 300 * (11/12) 550,000.00

    Mar _j_SQO. c:.gn ' V -5El(1--'t--3El9-*--f1·G I t2} l L.J,vOOilO

    Apr 3,500 3,000 3,000* 300 * (9/12) 675,000.00

    May 2,000 600 600 * 300 * (8/12) 120,000.00

    Jun 1,000 1,500 1,500 * 300 * (7 /12) 262,500.00

    Jul 500 1;000 1,000 * 300 * (6/12) 150,000.00 •,

    Aug 1,500 750 750 * 300 * (5/12) 93,750.00

    Sep 2,500 1,300 1,300 * 300 * (4/12) 130,000.00

    Oct 1,000 800 800 * 300 * (3/12) 60,000.00

    Nov 1,500 1,000 1,000 * 300 * (2/12) 50,000.00

    D ec 1,000 900 900 * 300 *(1 / 12) 22,500.00

    Total 20,000 14,850 2,688,750.00 -2% withholding

    Tax = ; 2,634,975.00

    3. Second tranche (60%)

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    a. The Konsulta provider will receive a maximum of PhP450/PhP300 of the per capita payment rate based on size of the catchment population as of December that year and achieved performance targets at the end of the year.

    b. The performance factor is the cumulative resultant score based on the performance of the provider adjusted using weigh ts set by the Corporation. The following are the performance targets which constitute the performance factor.

    Table 3: Performance Indicators in computing for the Performance Factor

    Indicators Description Formula Weight s

    1 Primary Unique registered No. of unique individuals Care beneficiaries who consult at leas t once 30% Consul tat consulted a primary 10n care doctor

    Total catchment population

    1 2% Withholding Tax for Private Facilities will be deducted in this amount ·.· : , , Page 2 of 4 of Annex H

  • ·----0 a

    :; .·_

    2 Utilization of Unique laboratory No. of unique laboratory Laboratory services done (50%) · service done 30% Services

    Total catchment population

    3 Dispensin Unique registered g of beneficiaries who No. of unique individuals

    Medicines received antibiotics as who received medicines for 10%

    prescribed by their conununicable diseases

    primary care .doctor ~ l Y IO) Total catchment population

    4 Unique registered beneficiaries who No. of unique individuals

    received N CD who received non-

    medication as communicable medicines 30%

    prescribed by their primary care doctor (20%)

    Total catchment population

    Sum of ail Indicators 100% Performance Factor x Weights

    c. Percentage of the tranche to be released will be based on the cumulative resultant score

    based on the performance of the provider.

    Table 4: Sample computation for the Second Tranche

    Performance Sample Computation Resultant Score Score

    Indicators / D escription per Dimension Formula:

    ' (Sc?re/Target)a X \X! eight

    a not to exceed 100%

    1 Primary Care 50% (50/100)*0.3 15% Consulta tion: Unique registered beneficiaries consulted a primary care doctor

    2 Utilization of 40% (40/50)*0.3 24% Laboratory Services: ' Unique laboratory

    ...

    services done (50%) . '

    Page 3 of 4 of Annex H

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    3 Dispensing of 10% (10/ 15)*0.1 6.6% Medicines: Unique registered beneficiaries who received antibiotics as prescribed by their primary care doctor (15%)

    4 Dispensing of 15% (15/20)*0.3 22.5% Medicines~e

    registered beneficiaries who received N CD medication as prescribed by their primary care doctor (20%)

    Performance Factor 68.1%

    d. · Resultant score will be multiplied to PhP300/ PhP450 and to the total no. of

    registered beneficiaries with first patient encounter as of December of the applicable year.

    e.

    f.

    Table 5: Sample computation for the Second Tranche for Public facili ty

    Second Tranche = No. of registered beneficiaries with first patient encounter X Performance Factor x (Capitation Amount X 60%)

    = 14,850 X 68.1% X (Php300.00) = Php3,033,855.00

    Table 6: Sample computation for the Second Tranche for Private facility

    Second Tranche = No. of registered beneficiaries with first patien t encounter X Performance Factor x (Capitation Amount X 60%)

    = 14,850 X 68.1% X (Php450.00) I = Php4,550,782.50 - 2% \.vithholding j[ax = Php4,459,766.85 .

    All encoded patient encounter data must be submitted to PhilHealth by the 30th calendar day of January of the immediate succeeding year. The computed performance tranche amount based on submitted patient encounter data will be released \vi thin 30 days from date of submission.

    4. Balance Billing/Co-Payment

    a. Private facilities shall be allowed to charge balance billing/ co-payment cap of

    Php500.00 on a per beneficiary basis.

    Page 4 of 4 of Annex H

  • !Annex I. Submission of Report (For tbe lst Tranche)

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    Page 2 of 2 of Annex I

  • ANNEXJ: List of Minimum Personal Information for the First Patient Encounter

    A. PhilHealth Identification Number (PIN)

    B. N ame (Last, First, Middle, Extension)

    C. Date of Birth

    D. Sex (Male/Female)

    E. Client Type (Member or Dependent)

    F. Past Medical History

    --------&.-Fa~~------------------------------------------------------

    Fasting Blood Sugar/ Random Blood Sugar

    H. Personal and Social History

    1. Smoking

    11. Alcohol

    ill. Illicit Drug

    1v. Sexually Active

    I. Vital Signs and Anthropometries

    1. Blood Pressure

    11. Heart Rate

    ill. Respiratory Rate

    1v. Temperature

    v. Height

    v1. Weight

    vii. BMI

    Pediatric Client (aged 0-24 months)

    1. Middle and Upper Arm Circumference

    11. Z-Score (aged 0-60 months)

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