PhilHealth extends DCPM coverage, includes claims received until Aug. 9

The Philippine Health Insurance Corp. (PhilHealth) announced Friday the second phase of implementation of the Debit-Credit Payment Mechanism (DCPM) that covers received in-process claims from April 8 to August 9, 2021.

Under DPCM, PhilHealth will initially pay 60% of claims to hospitals and the 40% will be paid upon completion of processing requirements.

The first phase of the DCPM was implemented for claims received from March 8, 2020 to April 7, 2021.

Meanwhile, the extended DCPM covering received in-process claims from April 8 to August 9, 2021, will still exclude claims that were returned to hospitals for compliance, denied, and under investigation for payment.

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, the state health insurer said.

The DCPM can be availed of by health care 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 (IATF/NTF)
• 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.

Eligible HCFs should submit a Letter of Intent and Undertaking to the concerned PhilHealth office or branch.

Once their application is approved, PhilHealth shall facilitate settlement of 60% of the HCF’s “good” in-process claims, subject to 2% expanded withholding tax for private HCFs.

The 40% 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.

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

Succeeding amendments shall be announced through a separate issuance, it added.—AOL, GMA News