PhilHealth Information System

How to Process the PhilHealth Benefits of the Patient?

 Table of Contents

Introduction.................................................................................................................. 4
PhilHealth Application Entries .......................................................................................... 5
PHIC Set-up ................................................................................................................. 5
Diagnosis Information ................................................................................................. 5
Senior Citizen Discount ............................................................................................... 6
Assigning Items and Services to a particular ICD-10 Code ............................................... 7
Assigning an Item as NHIP-Compensable..................................................................... 11
How to Add PHIC Application Entries? ............................................................................ 13
How to Edit PHIC Application Entries? ............................................................................ 14
How to Delete PHIC Application Entries? ......................................................................... 15
How to View PhilHealth Application Details? .................................................................... 16
PhilHealth Outright Deduction ....................................................................................... 18
How to Add PhilHealth Outright Deduction? .................................................................. 18
Case Payment Claims ................................................................................................ 18
Fee-for-Service ........................................................................................................ 26
Inpatient Coverage ...................................................................................................... 34
How to Edit PhilHealth Outright Deduction? .................................................................... 37
How to View PhilHealth Outright Deduction? ................................................................... 37
Printing of Claim Forms ................................................................................................ 38
PhilHealth Outright Filing .............................................................................................. 44
How to Process PhilHealth Outright Filing? ................................................................... 44
PhilHealth Outright Transmittal ..................................................................................... 45
How to Process PhilHealth Outright Transmittal? ........................................................... 45
Printing of PhilHealth Outright Transmittal Letter ............................................................. 47
Tagging of PhilHealth Entry as Returned Claim ................................................................ 49
How to Tag PHIC Outright Deduction Entry as Returned Claim? ...................................... 49
PhilHealth Outright RCTA Re-filing ................................................................................. 50
How to Process Outright RCTA Re-filing? ..................................................................... 50
For Philhealth Receivable: ............................................................................................ 51
Batch A/R Posting PhilHealth ...................................................................................... 51
PhilHealth Remittance Posting ....................................................................................... 53
How to Apply Collection of PHIC to the Patients? .......................................................... 53
Apply AR Transfer ....................................................................................................... 57
Apply Credit Memo ...................................................................................................... 60
Refund Processing ....................................................................................................... 63
PhilHealth Refund Deduction ...................................................................................... 63
Printing of Claim Forms ................................................................................................ 69
PhilHealth Refund Filing................................................................................................ 76
How to Process PhilHealth Refund Filing? ..................................................................... 76
PhilHealth Refund Transmittal ....................................................................................... 77
How to Process PhilHealth Refund Transmittal? ............................................................ 77
Printing of PhilHealth Refund Transmittal Letter .............................................................. 79
Tagging of PhilHealth Refund as Returned Claim ............................................................. 81
How to Tag PHIC Refund Entry as Returned Claim? ....................................................... 81
PhilHealth Refund RCTA Re-filing ................................................................................... 82
How to Process Outright RCTA Re-filing? ..................................................................... 82
PHIC OPD Consolidated Claims ...................................................................................... 83
Introduction
Welcome to BizBox PhilHealth Information System 8.0! We are proud to share with you the latest system that will go
hand in hand with the new Hospital System 8.0 to provide a better service to all of you our beloved clients. You might
notice that there are no previous versions of the PhilHealth Information System that is because this is a new system
unlike the earlier PhilHealth System that is attached to the Hospital System itself. We therefore decided to separate these
two entities such that services from the Hospital System and the PhilHealth System will be more specialized. In return the
services that will be given to the patients as well as the hospital administrators and staff and most especially to the PHIC
(PhilHealth Insurance Corporation) will be more efficient and effective.

This instruction manual will tackle the first process of the PhilHealth Information System and that is Outright Processing.
This is used together with the HS8 to help the Hospital to process the PhilHealth Filing Claim and Transmittal Preparation.
Please read through the following instructions and guidelines and make sure that you understand them so that you will be
able to do this procedure properly.
PhilHealth Application Entries
This module will help you track all patients who availed and submitted PHIC documents. This way, all the submitted
information of the patients will be more organized and used for them to receive their PHIC benefits.

PHIC Set-up
Managing the PHIC Set-up and Options and its effects on the system will be discussed here.

Diagnosis Information

1. Access PHIC>Set-up and Options, then look for PHIC Case Type Selection. Once you’ve found it, select
whether Based on ICD10 or Manually selected. After that, click Save and Close button.
 Based on ICD10 – Case type will be based on the Final Diagnosis
 Manually selected – Case type is selected manually even without the Final Diagnosis yet
Senior Citizen Discount
The PhilHealth-engaged Institutional Health Care Providers shall first deduct the twelve percent (12%) VAT exemption
from the total hospital charges; then deduct twenty percent (20%) Senior Citizen Discount from the difference; then
deduct the PhilHealth Benefit from the remaining amount. The balance (net of VAT exemption, SCD and PhilHealth
Benefit) shall be the co-payment (should there be any) of the senior citizen.

Set the PhilHealth Outright Deduction as net of Senior Citizen Discount

1. Access PHIC>Set-up and Options, then look for Set PhilHealth Outright Deduction As Net of Senior
Citizen Discount. Once you’ve found it, select Yes. After that, click Save and Close button.
Assigning Items and Services to a particular ICD-10 Code
On application of Outright Deduction, the items and services assigned here will automatically be covered by PhilHealth for
the corresponding ICD-10 Code.

1. On HIS, access ICD-10 Codes on the Main Explorer. All the existing ICD-10 codes will appear, select one to
modify then click Edit command button.
2. The ICD-10 Details window will appear click Assign Items and Services button.
3. Enable the checkbox to select an item or uncheck to deselect the item. After that, click Apply button.
4. Going back on the ICD-10 Details module, if decided to remove an item on the list, just enable the checkbox to
indicate it is removed. When you’re done, click the Save and Close button.
Assigning an Item as NHIP-Compensable
To make an item covered by PhilHealth, tag them as NHIP Compensable.

1. Go to HIS, access Items and Services module. Select an item from the list then click Edit command button.
2. Under the General tab, tick the checkbox to specify that the item is NHIP Compensable. Also, specify the
NHIP Category and Price. After that, click the Save and Close button.
How to Add PHIC Application Entries?
1. PHIC>Applications, click New command button or press Ctrl + N on your keyboard. The Patient Register
Selection window will appear, search and select the patient name.

2. On the PhilHealth Application Details specify the Entity Type, Membership, Notes.Remarks, if any and
the Application Date. Then on Application Requirement Approval Checklist, put a checkmark on the
entry/ies that were submitted and approved for the PHIC Application. Note: You can click the checkbox on the 1st
Column Header to select all the entries on the checklist. When you’re done, click Save and Create New or
Save and Close.
How to Edit PHIC Application Entries?
1. PHIC>Applications. The list of the existing PhilHealth applications will appear, select and highlight a patient
then click Edit command button or press Ctrl + E.
2. The PhilHealth Application Details will appear just like the image above. Update the necessary information on the
editable fields (Entity Type, Membership, Notes.Remarks and Application Date).
3. Check or uncheck the entries on the Application Checklist then click Save and Close to save the changes on
the Patients PHIC record.
How to Delete PHIC Application Entries?
1. PHIC>Applications. Select a patient’s record on the list then click Delete command button or press Ctrl + D.
2. The Password Validation Entry window will appear, enter Password to confirm deletion or Close to cancel.
How to View PhilHealth Application Details?
1. PHIC>Applications. Select a patient on the list then click View command button or click Application Details
under the Sub-Components.
2. The PhilHealth Application Details window will appear. Browse through the different PHIC information of the
chosen patient. When you’re done, click the Discard button.

How to Add an Entry on the PhilHealth Application Checklist?

1. PHIC>Applications>Tables and Templates>Application Checklist

2. The PhilHealth Application Checklist window will appear. Click Add button.
 3. On the Application Checklist Details window will appear. Key in the appropriate Description as well as the
Default Value (Yes or No) then click Save and Create New or Save and Close.

How to Edit an Entry on the PhilHealth Application Checklist?

1. Main Explorer>Applications>Tables and Templates>Application Checklist

2. The PhilHealth Application Checklist window will appear. Select and highlight an entry on the list then click
Edit button or press E.
3. The Application Details window will be displayed; update the information on the Description and Default
value fields.
4. Click Save and Close to apply the changes.

How to Delete an Entry on the PhilHealth Application Checklist?

1. Main Explorer>Applications>Tables and Templates>Application Checklist

2. The PhilHealth Application Checklist window will appear. Select and highlight an entry on the list then click
Delete button or press D.
3. The Delete Row window will appear, click Yes to continue with the deletion or No to cancel.
PhilHealth Outright Deduction
This module is used for patients who have applied for Outright Settlement. Creating New Outright Deductions will
reflect on the HIS Patient SOA Billing Statement.

Two types of Claims:

1. Case Payment Claims

- also called Per-Case Payment or Packages
- Hospital payment method that reimburses hospitals predetermined fixed rate for each treated case
- Single rate regardless of hospital category and length of stay
2. Fee-for-Service Claims
- Payment system in which health care providers receive payment for each unit of service.
- Expenditures increase if more services are provided or a more expensive service is substituted for a less
expensive one.
- Benefits depend on:
 hospital/doctor category
 case type of illness
 length of stay
- Needs itemization, benefits determined retrospectively

How to Add PhilHealth Outright Deduction?

Case Payment Claims

1. Main Explorer>Outright Deductions. Click New command button. On the Select PhilHealth Application
window, search the patient name then click Select button.
2. The PhilHealth Details will be displayed. Input information on the mandatory fields:
 Member Last Name and First Name
 Member ID No.
 Member Birth Date
 Click Member Contact Info. and enter the different contact information
 Note:
You can also click Apply Patient’s Address to get the existing address of the patient from HIS. Click Ok
when you’re done.

3. Select Package Type. (Not Applicable for Fee-For-Service payment) and indicate the Discharge Date.

4. Click on the following tabs to key in necessary information:

a. Computation Table – Using this tab, you can view the computation of the PHIC deduction to the patient’s
account. This will inform the patient on how much he needs to settle on his own and on how much the
PhilHealth will be able to cover on his account

b. Diagnosis Information – indicate the Final Diagnosis of the Patient by clicking + button.
 On the Post Final Diagnosis click Select from ICD Master button and the ICD-10 Code Selection List
will appear, search and select the applicable code/s to the patient.

 The selected final diagnosis will be reflected and enable the checkbox to assign the Primary diagnosis. After
that, click the Post button.
c. Physicians and Services – indicate the PHIC Type, Services Rendered, if any, PHIC Sign Date, No.
of Visits and Inclusive Date To.
 No. of Visits – should not exceed the total PHIC No. of Days under the Rooms and Beds tab

 If PHIC Type is Surgeon, click the leftmost button to add Surgical Procedure
 On the PHIC Surgical Procedure window select the Anaesthesiologist on the dropdown list. Click Close
when you’re done.

d. Item Analysis – put a checkmark on the Items and Services from Drugs and Medicines; X-Ray,
Laboratory, Others; and Operating Room. After that, indicate the PHIC Price.
Note: For Case Payment – Item Analysis has no effect in the computation since it will depend on the selected
Package Type

e. Rooms and Beds – specify the PHIC No. of Days of the Inpatient.
 f. Billing Statement – you can view the Patient’s Statement of Account together with the Debit, Credit
and Balance Amounts.

g. Other Information – this is a system generated template that contains other information about the
Patients’ PHIC Account.

5. Click Save and Create New or Save and Close when you’re done with the steps above.
Fee-for-Service
1. Main Explorer>Outright Deductions. Click New command button. On the Select PhilHealth Application
window, search the patient name then click Select button.
2. The PhilHealth Details will be displayed. Input information on the mandatory fields:
 Member Last Name and First Name
 Member ID No.
 Member Birth Date
 Click Member Contact Info. and enter the different contact information

Note:
You can also click Apply Patient’s Address to get the existing address of the patient from HIS. Click Ok when
you’re done.
3. Select Not Applicable as Package Type and indicate the Discharge Date.

4. Click on the following tabs to key in necessary information:

a. Computation Table – Using this tab, you can view the computation of the PHIC deduction to the patient’s
account. This will inform the patient on how much he needs to settle on his own and on how much the
PhilHealth will be able to cover on his account

b. Diagnosis Information – indicate the Final Diagnosis of the Patient by clicking + button.
 On the Post Final Diagnosis click Select from ICD Master button and the ICD-10 Code
Selection List will appear, search and select the applicable code/s to the patient.

 The selected final diagnosis will be reflected and enable the checkbox to assign the Primary diagnosis.
After that, click the Post button.
 c. Physicians and Services – indicate the PHIC Type, Services Rendered, if any, PHIC Sign Date, No.
of Visits and Inclusive Date To.
 No. of Visits – should not exceed the total PHIC No. of Days under the Rooms and Beds tab

 If PHIC Type is Surgeon, click the leftmost button to add Surgical Procedure
 On the PHIC Surgical Procedure window select the Anaesthesiologist on the dropdown list. Click Close
when you’re done.

d. Item Analysis – put a checkmark on the Items and Services from Drugs and Medicines; X-Ray,
Laboratory, Others; and Operating Room. After that, indicate the PHIC Price and SC (Senior Citizen)
Discount if the patient is a qualified to avail for that particular discount.
e. Rooms and Beds – specify the PHIC No. of Days of the Inpatient.

f. Billing Statement – you can view the Patient’s Statement of Account together with the Debit, Credit
and Balance Amounts.

g. Other Information – this is a system generated template that contains other information about the
Patients’ PHIC Account.
 5. Click Save and Create New or Save and Close when you’re done with the steps above.

Inpatient Coverage
PhilHealth provides subsidy for room and board, drugs and medicines, laboratories, operating room and professional fees
for confinements of not less than 24 hours.
* Not to exceed 45 days for each calendar year.

** Refers to a confinement or series of confinements of the same illness not separated from each other by 90 days within
a calendar year. In this case, a member or beneficiary is not entitled to another set of benefits until after 90 days. They
can only avail of the unused portion of the benefits and the room and board fees until the 45 days allowance is
exhausted.

Source: www.philhealth.gov.ph

However, a member can avail of new set of benefits if succeeding confinements are of different illness.
How to Edit PhilHealth Outright Deduction?
1. Main Explorer>Outright Deductions
2. Select and highlight a patient on the list then click command button.
3. The PhilHealth Details window will appear just like when you Create a New PHIC Outright Deduction.
4. Locate the field or tab where you want to update or edit the information.
5. Once you’re done, click Save and Close. a

How to View PhilHealth Outright Deduction?

1. Main Explorer>Outright Deductions
2. Select and highlight a patient on the list then click command button.
3. Once the PhilHealth Details appears, browse through the different information about the PHIC Outright
Deduction then double check if all the computations and other details are correct.
4. Click Close button when you’re done.
Printing of Claim Forms

1. On Outright Deductions modules, select a patient on the list then click Print Claim Forms under the Sub
Components

2. On the PhilHealth Claim Reports, select on Report Document Options then click Preview button.
3. Shown below is a Claim Form 2 for Circular 12, S-2010.

Note: When Total PhilHealth Benefit is shown on Benefit Package it is an indication of a Case Rate Payment, else Fee-
for-Service Payment.
4. Sample preview of Claim Form 3:
5. Sample Claim Form 4:
6. Sample preview of Medicare Analysis with Preparation / Code for 12, S-2010:
7. Sample preview of Claim Form 3 - Maternity Care Package:
PhilHealth Outright Filing
Before performing this task, make sure that the PHIC claim of the patient is already done in the PhilHealth Outright
Processing.

How to Process PhilHealth Outright Filing?

1. Main Explorer>Outright Deductions. Select a patient on the list then click Filing under Sub Components.
2. The PhilHealth Details will once again appear; select the Computation Table tab.

3. Once you’re done, click Save and Close button.

Note: You will notice that the 3rd column (Filed?) will be checked, that means that the Outright Filing process
was successful.
PhilHealth Outright Transmittal
How to Process PhilHealth Outright Transmittal?
1. Main Explorer>Outright Deductions>Sub Components>Transmit
2. The Transmittals window will appear; put a checkmark on the patient/s then click Apply Transmittal No.
button.
 3. On the PhilHealth Transmittal Processing Details, specify the Transmittal, Filing and Checked Dates
then click Continue.

Please be reminded of the Transmittal No. is necessary in printing of reports.

Note: You will notice that the 4th column (Transmitted?) of the patient chosen for PHIC Outright Transmittal will be
checked, that means that the process was successful.
Printing of PhilHealth Outright Transmittal Letter

1. Access the Reports Manager>Transmittal Letter - Outright Deduction. Click the leftmost button to preview
the report.
2. On the Transmittal Letter – Outright Deduction window, input the Transmittal No. and use the other filter
option. After that, click the Run Report button. The transmittal letter will then be displayed on the report viewer.
When you’re done, click the Close button.
Tagging of PhilHealth Entry as Returned Claim
PhilHealth returns claims that have insufficient documents or information back to the hospital. The system can now
recognize this as a returned claim.

Note: Cancelled/Remitted/Already Applied Credit Memo Record cannot tag as RCTA

How to Tag PHIC Outright Deduction Entry as Returned Claim?

1. Main Explorer>Outright Deductions. Select a patient on the list then click Tag as RCTA under Sub
Components.

2. The RTCA ReTransmittal Refile Details will appear. Do the following tasks:
a. Indicate the RCTA Date
b. Specify the Received Date
c. Enter your Remarks, if any

3. After that, click the Save button.

Note: You will notice that the 5th column (RCTA?) of the patient chosen for PHIC Outright Transmittal will be
checked, that means that the process was successful.
PhilHealth Outright RCTA Re-filing
Before doing this process, make sure that you tag the patient as Returned Claim.

How to Process Outright RCTA Re-filing?

1. Main Explorer>Outright Deductions. Select a patient on the list then click Tag as RCTA under Sub
Components.
2. On the RTCA ReTransmittal Refile Details indicate the Retransmittal and Refiled Date.
3. Click Save button when you’re done.

4. Please be reminded that the ReTransmittal No. is necessary in printing of reports.

Note: You will notice that the 7th column (Re-Transmitted?) of the patient chosen for PHIC Outright Transmittal will
be checked, that means that the process was successful.
For Philhealth Receivable:
Batch A/R Posting PhilHealth
Please make sure the Outright Deduction to the patient was Filed and Transmitted.

1. Access the Batch A/R Posting PhilHealth under the Processing & Queries. Note: Only the Hospital Bill will be
reflected in this Module.

2. The Post to Accounts Receivable Subsidiary PhilHealth window will appear, specify the A/R Date Range to
display the ARs transmitted by PhilHealth. This should be 15 th or 30th of the month. Then click the Apply Filters
Preferences. Select All or choose one by one the AR by enabling the checkbox then click Next.
3. Specify the A/R Date (this should be within the specified A/R Date Range) then click Post button.
PhilHealth Remittance Posting
How to Apply Collection of PHIC to the Patients?
1. To apply the collection of PhilHealth to the patients, go to PhilHealth Information System>Outright
Deductions then access Apply Cash Receipts for HB under the Processing & Queries.
2. The Outstanding A/R PhilHealth window will appear, search and select the patient name paid by philhealth.
Specify the Amount paid in the For Remittance column. After that, click the Next button.
3. The information will be retained reflecting the For Remittance amount in the Amount for Posting, click Next button
to proceed.
4. Search and select the corresponding OR number.
5. The PhilHealth Official Receipts Application window will then appear, click Go button.
Apply AR Transfer
This module will forward the Outstanding balance to the patient.

1. On Outright Deductions, access Apply AR Transfer under Processing & Queries.

2. On the Accounts Receivable Details window, enable the checkboxes to select the outstanding balances to be
forwarded to the patient, then click Next.
3. The information will retain in the window, click Post button.
4. The Transfer of Accounts Receivable window will appear. Input the remarks, if any. After that, click Go to
proceed.
Apply Credit Memo
This module will remit the Outstanding balance as Expense of the hospital.

1. On Outright Deductions, access Credit Memo HB under Processing & Queries.

2. On the Outstanding A/R PhilHealth window, input the Amount in For Remittance to select the patient’s
record then click Next.
3. The information will be retained, click Next.
4. Select the Transaction Type on the dropdown selection list then click Go to proceed.
Refund Processing
This process is used if the PhilHealth Filing Claim and Transmittal Preparation are done by the patient. Using this module,
the hospital helps the patient to prepare the necessary requirements in claiming their benefits directly from PhilHealth.

PhilHealth Refund Deduction

This module is intended to process the PHIC deduction of the patient who applied for Refund Processing. The patients
must be on the discharged status before they can file for refund.

1. Main Explorer>Refunds. Click New command button. On the Select PhilHealth Application window,
search the patient name then click Select button.

2. The PhilHealth Details will be displayed. Input information on the mandatory fields:
 Member Last Name and First Name
 Member ID No.
 Member Birth Date
 Click Member Contact Info. and enter the different contact information
 Note:
You can also click Apply Patient’s Address to get the existing address of the patient from HIS. Click Ok
when you’re done.

3. Select Package Type. (Not Applicable for Fee-For-Service payment) and indicate the Discharge Date.

4. Click on the following tabs to key in necessary information:

h. Computation Table – Using this tab, you can view the computation of the PHIC deduction to the patient’s
account. This will inform the patient on how much he needs to settle on his own and on how much the
PhilHealth will be able to cover on his account

i. Diagnosis Information – indicate the Final Diagnosis of the Patient by clicking + button.

 On the Post Final Diagnosis click Select from ICD Master button and the ICD-10 Code Selection List
will appear, search and select the applicable code/s to the patient.
 The selected final diagnosis will be reflected and enable the checkbox to assign the Primary diagnosis. After
that, click the Post button.

j. Physicians and Services – indicate the PHIC Type, Services Rendered, if any, PHIC Sign Date, No.
of Visits and Inclusive Date To.
 No. of Visits – should not exceed the total PHIC No. of Days under the Rooms and Beds tab

 If PHIC Type is Surgeon, click the leftmost button to add Surgical Procedure
 On the PHIC Surgical Procedure window select the Anaesthesiologist on the dropdown list. Click Close
when you’re done.
k. Item Analysis – put a checkmark on the Items and Services from Drugs and Medicines; X-Ray,
Laboratory, Others; and Operating Room. After that, indicate the PHIC Price.
Note: For Case Payment – Item Analysis has no effect in the computation since it will depend on the selected
Package Type

l. Rooms and Beds – specify the PHIC No. of Days of the Inpatient.
 m. Billing Statement – you can view the Patient’s Statement of Account together with the Debit, Credit
and Balance Amounts.

n. Other Information – this is a system generated template that contains other information about the
Patients’ PHIC Account.

5. Click Save and Create New or Save and Close when you’re done with the steps above.
Printing of Claim Forms

1. On Refunds modules, select a patient on the list then click Print Claim Forms under the Sub-Components

2. On the PhilHealth Claim Reports, select on Report Document Options then click Preview button.
3. Shown below is a Claim Form 2 for Circular 12, S-2010.

Note: When Total PhilHealth Benefit is shown on Benefit Package it is an indication of a Case Rate Payment, else Fee-
for-Service Payment.
4. Sample Official Billing Statement
5. Sample preview of Medicare Analysis with Preparation / Code for 12, S-2010:
6. Sample preview of Claim Form 3 - Maternity Care Package:
PhilHealth Refund Filing
Before performing this task, make sure that the PHIC claim of the patient is already done in the PhilHealth Outright
Processing.

How to Process PhilHealth Refund Filing?

1. Main Explorer>Refunds. Select a patient on the list then click Filing under Sub Components.
2. The PhilHealth Details will once again appear; select the Computation Table tab.

3. Once you’re done, click Save and Close button.

Note: You will notice that the 3rd column (Filed?) will be checked, that means that the Refund Filing process
was successful.
PhilHealth Refund Transmittal
How to Process PhilHealth Refund Transmittal?
1. Main Explorer>Refunds>Sub Components>Transmit
2. The Transmittals window will appear; put a checkmark on the patient/s then click Apply Transmittal No.
button.
 3. On the PhilHealth Transmittal Processing Details, specify the Transmittal, Filing and Checked Dates
then click Continue.

Please be reminded of the Transmittal No. is necessary in printing of reports.

Note: You will notice that the 4th column (Transmitted?) of the patient chosen for PHIC Refund Transmittal will be
checked, that means that the process was successful.
Printing of PhilHealth Refund Transmittal Letter

1. Access the Reports Manager>Transmittal Letter - Refund. Click the leftmost button to preview the report.
2. On the Transmittal Letter – Refund window, input the Transmittal No. and use the other filter option. After
that, click the Run Report button. The transmittal letter will then be displayed on the report viewer. When you’re
done, click the Close button.
Tagging of PhilHealth Refund as Returned Claim
PhilHealth returns claims that have insufficient documents or information back to the hospital. The system can now
recognize this as a returned claim.

Note: Cancelled/Remitted/Already Applied Credit Memo Record cannot tag as RCTA

How to Tag PHIC Refund Entry as Returned Claim?

1. Main Explorer>Refunds. Select a patient on the list then click Tag as RCTA under Sub Components.

2. The RTCA ReTransmittal Refile Details will appear. Do the following tasks:
d. Indicate the RCTA Date
e. Specify the Received Date
f. Enter your Remarks, if any

3. After that, click the Save button.

Note: You will notice that the 5th column (RCTA?) of the patient chosen for PHIC Refund RCTA will be checked,
that means that the process was successful.
PhilHealth Refund RCTA Re-filing
Before doing this process, make sure that you tag the patient as Returned Claim.

How to Process Outright RCTA Re-filing?

5. Main Explorer>Refunds. Select a patient on the list then click Tag as RCTA under Sub Components.
6. On the RTCA ReTransmittal Refile Details indicate the Retransmittal and Refiled Date.
7. Click Save button when you’re done.

8. Please be reminded that the ReTransmittal No. is necessary in printing of reports.

Note: You will notice that the 7th column (Re-Transmitted?) of the patient chosen for PHIC Refund RCTA
ReTransmittal will be checked, that means that the process was successful.
PHIC OPD Consolidated Claims
1. On the PhilHealth Information System, Outright Deductions>Package Types. An identifier is now included to
specify the package as a Hemodialysis Package.
2. The system will also include additional checkbox in the Outpatient Registration as an identifier of the Hemodialysis
patient.
3. Going back to PHIC, access the Outright Deductions module then click the Hemo OPD Outright Deduction
under the Processing & Queries. The PhilHealth Hemodialysis Claim Form 2 window will appear, specify the
Reference Date Range and click the Apply Filter button. The Hemodialysis patient will now appear; select a
patient from the list then click Select button.
4. The PhilHealth Details window will be shown. Select the Hemodialysis Package. This will be used to process the
Claim Form 2. After entering all the necessary information, click the Save and Close button.
5. To preview all the transactions made from Hemo OPD Outright Deduction, click the Hemodialysis Claim Form 2
under the Processing & Queries. Select the Hemodialysis patient on the list then click Preview button.
6. PhilHealth Claim Form 2 will be displayed on the report viewer reflecting the Hemodialysis package.