PhilHealth’s DCPM includes claims received until Aug. 9

MANILA, Philippines — The Philippine Health Insurance Corporation (PhilHealth) announced on Friday the second implementation of its Debit-Credit Payment Mechanism (DCPM) that covers received in-process claims from April 8 to August 9.

In a statement, PhilHealth said the second installment of the DCPM will still exclude claims that were returned to hospitals for compliance, denied, and under investigation for payment.

Under the DPCM, only 60 percent will initially be paid to hospitals while 40 percent would be paid upon completion of processing requirements. The DPCM was first implemented for claims received from March 8 to April 7.

“In addition, claims directly filed by the member, claims with invalid illness codes, and initially identified in-process claims included in the first implementation of DCPM that were returned-to-hospital and has been received by PhilHealth within the inclusive period of the second implementation of DCPM shall likewise be excluded from the computation of applicable in-process claims,” said PhilHealth.

According to the state health insurer, the DCPM can be availed by healthcare facilities (HCFs), including previous recipients from the initial implementation of the payment mechanism that meet the following criteria:

• Must be in high and critical areas identified by the Inter-Agency Task Force or National Task Force Against COVID-19
• Must have no Interim Reimbursement Mechanism fund balance on record
• With claims for PhilHealth COVID-19 packages
• Was not serving the penalty of suspension during the applicable period

PhilHealth said eligible HCFs should submit a Letter of Intent and Undertaking to the concerned PhilHealth office or branch. Once their application is approved, the agency shall facilitate settlement of 60 percent of the HCF’s “good” in-process claims, subject to two percent expanded withholding tax for private HCFs.

“The 4% balance shall be fulfilled following full compliance to existing claims processing requirements and full reconciliation of the initial 60% payment. This is also subject to 2% expanded withholding tax,” it added.

PhilHealth said it may modify the inclusive dates of DCPM claims subject to the approval of its Board of Directors, to allow immediate compensation of services delivered by its health partners.

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/MUF