We would like to inform you about the recent PhilHealth Circular published on July 1, 2024, which introduces important updates regarding hemodialysis coverage for beneficiaries with Chronic Kidney Disease Stage 5 (CKD5). This circular establishes rules for availing the adjusted case rates for 156 hemodialysis sessions per year.

Below are some frequently asked questions (FAQs) to help you understand the details and implications of this new policy.

-It outlines the rules for availing the adjusted case rates for 156 hemodialysis sessions, specifically for beneficiaries with Chronic Kidney Disease Stage 5 (CKD5) registered in the PhilHealth Dialysis Database (PDD).

-PhilHealth beneficiaries diagnosed with CKD5 are eligible, provided they are registered in the PhilHealth Dialysis Database (PDD).

The PDD is a database where all patients diagnosed with CKD5 must be registered, as per PhilHealth Circular No. 2016-0007. Registration ensures eligibility and facilitates the availing of benefits under this circular.

-The benefit package amount has increased from Php 2,600 to Php 4,000. This amount is divided between the health facility (HF) and the professional fee.

-There will be no EXE update required for this amended Circular as the process of submission remains unchanged. However, we advise that the submission of multiple sessions is not allowed. This is reinforced by a system alert received when sending multiple sessions, indicating that PhilHealth has added a validation in the system to prevent such submissions. Furthermore, verbal confirmation from PhilHealth's main office has clarified that all future submissions must be on a per-claim basis.

Additional Note: If a patient is admitted (registered as IPD) due to CKD5 and requires hemodialysis, you will still need to file it separately by creating another registration under OPD. All charges associated with hemodialysis will be applied to the OPD registration.

Previous submissions that were done per multiple sessions will not be affected by these changes. The new requirement for submitting on a per-claim basis only applies to future submissions. All past submissions processed as multiple sessions should remain unaffected and valid as they adhered to the guidelines in place at the time of their submission.

For HIS users, you can temporarily use the existing feature for "Is Stroke / Pneumonia" where users can input the new amount. Please note that this feature is only available in exe version 8.26.14.44 to latest versions.

For older versions of HIS, you can consider adding another RVS code 90935. You will need to provide a description to identify that this is the new amount for processing claims affected by this Circular, effective from July 1 onwards.

-For Beacon users, the update to the case rate package of Php 4,000 is expected to be automatic and will depend on the update from the eClaims webservices. Upon checking, the updated case rate amount of Php 4,000 is already reflected on the Beacon Portal.

Since the update is in place, for previous claims that still apply to the old case rate of Php 2,600, you will need to manually update the correct case rate amount. Please refer to the provided image or guidelines for step-by-step instructions on how to manually update the case rate package to Php 2,600.

-The PhilHealth Circular 2024-0014 takes effect on July 1, 2024, as published in the Manila Standard on the same date. Please refer to the PhilHealth Circular for the amended details of this circular. (https://www.facebook.com/share/p/Qvu2RLd9qvBwpBNX/)

We encourage our valued clients to thoroughly review the latest PhilHealth Circular to ensure compliance with the amended guidelines. It's important to stay updated and adhere to the revised procedures for smooth and accurate processing.

Best regards,

BizBox Team