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PhilHealth implements e-Claims Project

PhilHealth has announced the Phase I implementation of the e-Claims Project in its recently released PhilHealth Circular No. 014 s-2011. The project promotes and enables online connection of hospitals and healthcare facilities to PhilHealth which will eventually lead to online submission of claims. Through the Claims Eligibility Web Service (CEWS), hospitals and health care facilities may now directly verify eligibility status of PhilHealth members and dependents using their own system.

The CEWS aims to:

• Speed up the eligibility verification of the hospitals;
• Reduce Return-to-Sender (RTS) claims due to member eligibility issues/problems.

The web service shall facilitate the verification of the following areas:

• Existence of the PhilHealth member;
• Qualified dependents;
• Qualifying contributions;
• 45-days limit for room and board of members and/or dependents.

Requirements in Connecting to the CEWS:

• The hospital or facility must have an existing hospital information system;
• Internet connection;
• Capacity to modify existing hospital information system or develop a prototype to connect to PhilHealth through the CEWS.

For additional information, please refer to the circular.

All hospitals or facilities interested in participating in the e-Claims Project may submit a written expression of interest to PhilHealth.