PHIC OFFICE ORDER NO. 183, s. 2000, March 28, 2000

[ PHIC OFFICE ORDER NO. 183, s. 2000, March 28, 2000 ]

CLAIMS DENIED DUE TO UNNECESSARY CONFINEMENT

Numerous claims were first filed way back in late 1997 and early 1998 at the Claims Processing Department (CPD) and denied due to unnecessary confinement , which are being continually appealed at the Claims Review Unit (CRU) by the concerned health care providers and/or members. To expedite the processing of these claims, a PhilHealth memorandum dated Dec. 10, 1998 was issued which provides that "all claims previously denied by the CPD for unnecessary confinement are hereby granted reconsideration...". In view of the foregoing and effective immediately, all claims denied due to unnecessary confinement which are being appealed and being acted upon at the CRU including future appeals of this nature be directed to the CPD for processing and payment subject to their re-evaluation of available documents on hand based on existing guidelines and policies of the Corporation.

Adopted: 28 March 2000

(SGD.) ENRIQUE M. ZALAMEA President and CEO