DOCTORS, dentists and midwives accredited by the Philippine Health Insurance Corporation (PhilHealth) will soon be able to track the status of claims for the payment of their professional fees (PF).
Through the Health Care Professional Portal (HCProf Portal), these accredited health care professionals can monitor the progress of reimbursement claims filed by accredited health care institutions (HCIs) for services rendered to PhilHealth members. It is an initiative of the Benefits Committee of the PhilHealth Board of Directors.
“This is the newest online service that we are offering to our partner-providers,”said Dr. Celestina Ma. Jude P. de la Serna, Interim/Officer-in-charge, PhilHealth President and CEO. “We really wanted to introduce something like this so that accredited medical professionals can also keep track of their PF payment status,”she said.
When PhilHealth introduced the All Case Rate provider payment mechanism in 2011, the PF payment was lumped with the reimbursement for hospital charges. The HCIs were tasked to distribute the PFs to the medical professionals who were, in turn, dependent on the HCIs for the schedule of payment for professional medical services given to PhilHealth members.
“We hope to address the concerns raised by our accredited medical professionals when it comes to the status of their PF payments,” de la Serna said.
Earlier, PhilHealth Circular 0035 series of 2013 mandated HCIs to distribute the PF to the concerned accredited medical professionals within 30 calendar days from receipt of reimbursement from PhilHealth. Otherwise, they will be violating the provisions of their Performance Commitments.
The HCProf Portal provides users with information on the date the claim for reimbursement was filed, total reimbursement amount and the status of the claim, whether it is still in process, was returned to the hospital or denied.
To access the HCProf Portal, accredited health care professionals must provide PhilHealth with their active email addresses, PhilHealth Identification Numbers, or accreditation numbers, for these are vital to the authentication and activation of their portal accounts. “They can actually access the HCProf Portal by using only the last eight (8) digits of their PhilHealth Accreditation Numbers as user accounts,” de la Serna added. The prefix code and the hyphen of their PAN should be excluded.
PhilHealth, however, reminded users of the HCProf Portal that they must always abide by the provisions of the Data Privacy Act of 2012 by securing their accounts and registered email addresses. Should there be any indications that their accounts have been hacked, these should immediately be reported to PhilHealth through its 24/7 Corporate Action Center Hotline, (02) 441-7442.
Eventually, the HCProf Portal will enable accredited medical professionals to file their applications for accreditation and determine the status of their applications electronically. It will also enable them to receive notifications and reminders from PhilHealth. “More online services will be introduced for our partner-providers so that transacting with us becomes more convenient for these very busy professionals,” the PhilHealth Chief stressed.
To date, there are over 30,000 accredited health care professionals nationwide, 16,242 of whom are medical specialists, 14,225 are general practitioners, 1,618 are midwives and 335 are dentists. Earlier, PhilHealth announced that it is now ready to accredit nurses for the delivery of maternity care, newborn care and normal spontaneous delivery packages in accredited birthing homes nationwide. (END)
