To all eClaims users,

According to PhilHealth Circular No. 2021-0012, Modification of Payment Rules for Benefits Packages under the All Case Rates (ACR) Policy, including COVID-19 Benefit Packages, hospitals will be reimbursed based on either the set case rate or actual charges, whichever is lower. Given the fact that claims are submitted electronically to PhilHealth, Bizbox inquired as to whether any changes will be made to the system in preparation for the 15-day implementation of this new circular. With this, we have submitted the following queries thru PhilHealth Ticketing System. Here is the list of our queries:

1. Are we going to edit the case rate amount(pCaseRateAmount) in eClaims xml portion by stamping whichever is lower instead of Case Rate amount?

2. Is the PhilHealth Statement of Account presentation should be adjusted? The PhilHealth Benefits in Statement of Account of Account reflected the Case Rate amount.

3. Is the CF2 printout in Consumption of Benefits for PhilHealth benefits to be adjusted? In our system it always reflected the Case Rate amount

4. Is the eClaims XML portion in Consumption of Benefits to be also adjusted? In our system the pPhilhealthBenefit field always reflected the Case Rate amount in Search Case Rate.

All of these concerns are addressed by the PhilHealth team by stating that NO CHANGES will be made to the system. This circular will be implemented internally across all Regional Offices. Additionally, our submitted ticket was marked as Closed. If you have any questions that are not addressed above, please contact us so we can communicate them to PhilHealth.

Thank you very much.