Supplemental Guidelines to PhilHealth Circular 15 s. 2012 Re: PhilHealth for Animal Bite Package

June 20, 2012

PHILHEALTH CIRCULAR NO. 033-12

 

In order to facilitate implementation of Animal Bite Package (ABP) and hasten participation of interested providers of this package, the following additional guidelines shall be followed:

A. Provider Engagement

1. For CY 2012, in lieu of the Certificate of Recognition as an Animal Bite Treatment Center or Animal Bite Center from the DOH, all ABTCs and ABCs found in Annex A, a list of facilities capable of managing animal bites as certified by the DOH-NCDPC, shall be eligible to participate as providers for the ABP. These facilities are given until July 31, 2012 to submit the provider's data record and signed PC for HCP in order to receive reimbursement.

2. Submission of the Certificate of Recognition from the DOH as an ABTC/ABC shall follow upon issuance by said DOH office/s or upon renewal of participation in the Program, whichever comes first.

3. HCPs with intention to participate shall use the Performance Commitment (PC) for Health Care Providers (HCP) attached to PhilHealth Circular 13 s. 2012.

4. ABP provider which submitted provider's data record (PDR) and signed PC on or before July 31, 2012 shall be eligible for reimbursement beginning May 3, 2012. This means that treatment provided to PhilHealth members starting May 3, 2012 will be retroactively computed and reimbursed.

5. PDR and signed PC submitted after July 31, 2012, shall render the provider eligible for reimbursement of claims for completed treatment beginning on the date it complied with the requirements as stated in PhilHealth Circular 13 s. 2012. Claims filed for completed treatment prior to the date of compliance will NOT be reimbursed.

6. Direct file from patients from May 3, 2012 may be reimbursed provided that the claims are filed within 60 days from completion of day 7 treatment or in cases mentioned in B.1 of the circular, in any of the ABTCs in the list.

7. For directly filed claims, the beneficiary shall submit claim form 2 and a certified true copy of the completely filled-out Animal Bite Treatment Record. SEACTH

8. All IHCPs eligible as provider of ABP shall put a signage following the attached design and technical specifications. (Annex B)

B. Benefits Availment

1. Guidelines in the proper filling-up of Claim Form Summary Report is provided herein (Annex C).

2. In cases where day 3 and/or day 7 was/were not administered because of confinement or death, the full package shall be paid to the health facility. These shall be supported by the applicable documents:

a. Deceased: Death Certificate or Certification of Death issued by the MHO/CHO

b. Admitted in a hospital: Certificate of Admission issued by the hospital

c. Repeat exposure — Animal bite treatment record reflecting the date/s of administration of the booster dose/s

3. Strict compliance to the "No Balance Billing Policy" for sponsored members shall be enforced.

4. To ensure completion of appropriate treatment, the member shall complete the treatment in one accredited provider.

5. Complete and proper filling-up of the summary claim form is advised in order to prevent denial or return of claim applications. (Please refer to annex for details)

6. To ensure efficient utilization of the reimbursements, LGUs with accredited ABP providers are encouraged to create a trust fund for PhilHealth reimbursements that will ensure availability of a revolving fund.

All issuances that are inconsistent with the provisions of this Circular are deemed superseded. TcDaSI

For information and guidance.

(SGD.) DR. EDUARDO P. BANZONPresident and CEO

ANNEX A

DEPARTMENT OF HEALTHNational Center for Disease Prevention and Control-Infectious Disease OfficeNational Rabies Prevention and Control Program

List of Animal Bite Treatment Centers (ABTC)

SUMMARY

Region	ABTC	ABC
I	17
II	16
III	28
IV-A	48
IV-B	34
V	24
NCR	21
CAR	8
	––––
Luzon	196
VI	34	1
VII	27	3
VIII	16
	––––
Visayas	77
IX	17
X	20
XI	19	4
XII	11
CARAGA	21
ARMM	4
	––––
Mindanao	92
Luzon	196
Visayas	77	4
Mindanao	92	4
	–––––	–––
Total ABTCs	365	8
	=====	===

 

ANNEX B

ANNEX C

Proper filling up Animal Bite Package Forms for Reimbursement

A. Claims Summary Report (CSR)*

1. Indicate Provider Code or Accreditation number in the space provided

2. Columns:

a. Patient's name

b. Encircle the letter M if patient is member or D if dependent

c. PIN (PhilHealth Identification Number)

d. ICD code of the diagnosis

e. Date of administration of the 1st dose of anti rabies vaccine (ARV)

f. Date of administration of Day 3 ARV

g. Date of administration of Day 7 ARV

h. Date Rabies Immunoglobulin was administered

i. Signature of member to confirm services were rendered

3. Authorized signatory at the lower left portion of the form is the personnel in charge of filling up of PhilHealth claims

4. Head of facility — MHO, CHO or Chief of Clinic

Note:

• Each patient or member's claim listed should have Claim Form (CF)1 attached. If there are 7 patients listed, there should be 7 claim form 1 attached to the CSR.

• Incomplete data in CSR may result in withholding of reimbursement subject to submission of Animal Bite Treatment Record.

* The CSR is a list of patients who are recipient of ABP and whose reimbursement shall be paid to the facility.

B. Claim Form 2 for directly Filed Claims

All items must be properly filled-up

Part 1

• Item #10. Confinement period

a. Date admitted — Day 0 of treatment

b. Date discharged — Day 7 of treatment

e. No. of days claimed — 1

• Item #11 e. aEHIDT

11.	Health Care Provider	Actual Charges	PhilHealth Benefit	For PhilHealth
	Services			use only
e.	Benefit packages-ABP	P3,000	P3,000

 

• Item #16. Leave this blank if patient is private

Part II

• Under the Generic/Brand name, write the immunizations and date administered.

 To illustrate:

 Part II Drugs and Medicines

	Part II Drugs and Medicines
Generic/Brand Name	Preparation	Quantity	Unit Price
RIG — May 3, 2012	____________	__________	__________
Day 0 — May 3, 2012	____________	__________	__________
Day 3 — May 6, 2012	____________	__________	__________
Day 7 — May 10, 2012	____________	__________	__________

• In case of incomplete vaccination due to hospital admission or death of patient, write the word admitted and the name of the hospital and date of admission (in case of admission) or date of death (as the case maybe). aEHIDT

 To illustrate:

a) Hospital admission of patient

	Part II Drugs and Medicines
Generic/Brand Name	Preparation	Quantity	Unit Price
RIG — May 10, 2012	____________	__________	__________
Day 0 — May 10, 2012	____________	__________	__________
Day 3 — Admitted; Phil. Gen.	____________	__________	__________
Hospital; May 11, 2012

 

b) Repeat exposure

Generic/Brand Name	Preparation	Quantity	Unit Price
RIG —	____________	__________	__________
Day 0 —	____________	__________	__________
Day 3 —	____________	__________	__________
Day 7 —	____________	__________	__________
Day 28 —	____________	__________	__________
Booster 1 — May 12, 2012	____________	__________	__________