PhilHealth strengthens drive vs bogus claimants
In order to further protect government funds and make the lives of conmen harder, the Philippine Health Insurance Company (PhilHealth) has now devised a new plan aimed at ensuring rightful claims of rightful claimants.
As such, PhilHealth members are now advised to attach a copy of Member Data Records (MDR) to documents backing up hospitalization claims including that of legal dependents.
Contained in Circular 07, series of 2007 as amended, Lorna O. Fajardo, Acting PhilHealth President and Chief Executive Officer called for the support of the 64 million-strong PhilHealth members.
In a news release sent to The News Today (TNT), Fajardo explained that the additional requirement will strengthen data verification at the hospital level "by ascertaining the identity and eligibility of their legal dependents who are availing themselves of benefits under their membership."
The new policy applies to claims with admission dates starting September 1st of this year, the news release continued.
"We are now making the Member Data Record (MDR) a primary document in claim applications to also reduce the incidence of claims being returned to the hospital as well as claims that are doubtful in nature," Fajardo said. As such, she added, "all PhilHealth members, including those from the employed sector, are now required to submit and attach a clear copy of the MDR to PhilHealth Claim Form 1" when filing for benefits for a dependent's confinement.
The MDR is a document that lists the primary information on a PhilHealth member. It also contains the names of the member's qualified legal dependents and is used for reference purposes during benefits availment.
If a member is not able to present an updated MDR, secondary supporting documents such as birth certificate, marriage contract and other documents may be accepted to ensure benefit claim availment.
"Members who do not yet have a copy of their MDRs may secure copies, free-of-charge, from any of our 17 Regional and 84 Service Offices nationwide," Fajardo said. In case of discrepancy between what the MDR lists and the member's or dependents' true information, members are encouraged to fill out Form M2 or the data amendment form and to attach to it all the supporting documents to establish dependency. "We hope to ensure that only those who are qualified to avail of the medical care benefits are granted the hospitalization package in any of our accredited partner-hospitals nationwide," Fajardo stressed.