New Features

PHIC New Case Rate

Table of Contents
New Case Rate ..................................................................................................... 3
Setup ................................................................................................................................................................................... 3
Medical Case Rate ............................................................................................................................................................... 9
Surgical Case Rate ............................................................................................................................................................. 14
Medical and Surgical Case Rate ........................................................................................................................................ 21
Special Cases ..................................................................................................................................................................... 27

Claim Form 2 Printing .......................................................................................... 31

Medical Case Rate 1st page ............................................................................................................................................... 32
Medical Case Rate 2nd Page .............................................................................................................................................. 35
Surgical Case Rate CF2 1st Page ......................................................................................................................................... 37
Surgical Case Rate CF2 2nd Page ........................................................................................................................................ 38
Both Medical and Surgical Case Rate CF2 1st Page ........................................................................................................... 39
Both Medical and Surgical Case Rate CF2 2nd Page........................................................................................................... 40
CF2 1st Page (with Outside charges).................................................................................................................................. 41

New Case Rate

Setup
1. First we must activate the set-up. On the PhilHealth Information System, go to the Setup and Options module and look for Activate PHIC Case Rate then set the Value to
Yes.

2. Also, change the value of Activate Philhealth Web Service to Module 1. After that, click
the Save and Close button.

3. Next, proceed to Outright Deductions module. There will be new transactions on Tables and
Templates, the eClaims Case Rate. Upon click, the PhilHealth eClaims Case Rate window
will appear then tick the Add button. Then the PhilHealth eClaims Case Rate Details
window will appear. Fill in the following fields:
a.
b.
c.
d.

Code
Description
Package
Package Amount
i. First Case Rate
ii. Second Case Rate

Check the Is Active? box if applicable. After that, click the Save and Close button.

4. Meanwhile, in HIS > ICD 10 Codes, choose an ICD Code then click Edit. Enable the Is Case
Rate? checkbox then select the assigned Case Rate. After that, click the Save and Close
button.

Note:
All Case Rates initially provided by PhilHealth are included in the default build-up on the
latest executable file version (8.24.0.59 or higher), and these are automatically linked to
ICD-10 Codes module. In case ICD 10 Code is not available in the clients database buildup, user may add the ICD 10 manually in the system and path the assigned Case Rate.
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5. On the other hand, for the setup in Surgical Procedures, go to PHIC > Outright
Deduction> Surgical Procedures, new fields were added on Surgical Procedure Details
window. Fill up the following fields:
a. Category select from the drop-down list
b. Custom Code input the RUV Code
c. Description
d. OR Type select from the drop-down list
e. RUV Value
f. Package Amount
i.
First Case Rate
ii.
Second Case Rate

6. Proceed with the deductions processing. On the Outright Deduction > New > PhilHealth
Details, fill-in all the mandatory fields. Choose Case Rate as the Claim Type.

7. On the Diagnosis/Case Rate tab, click this

button to assign the Final Diagnosis.

Medical Case Rate

8. The Final Diagnosis window will appear. If the patients case rate is Medical, click the Select
from ICD Master List button.

9. The ICD-10 Code Selection List window will appear. Choose the ICD 10, then click Select.

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10. Back to Post Diagnosis window, choose the Primary Diagnosis, First Case Rate and
Second Case rate by clicking the checkboxes. Click Post to continue.

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11. Back to Diagnosis/Case Rate tab, the Package Amount set to the assigned Case Rate will
appear on the Case Rate Details.

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Surgical Case Rate

12. If the patients case rate is Surgical, on the Outright Deduction > PhilHealth Details >
Diagnosis/Case Rate tab, select ICD 10 Codes then click the Primary or the 1st column
check box. After that, click the Post button.

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13. After that on the Physical and Services tab, click the button on the 1st column.

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14. The PHIC Surgical Procedure window will appear. Click the Add button. Select

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15. On the Select Surgical Procedure window, choose on the list then click the Select button.

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16. Back to the PHIC Surgical Procedure window, click the 1st check box to assign the surgical
procedure as the First Case Rate. After that, click the drop-down to select the ICD 10 Code.
Assign also the Anesthesiologist.

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17. If there is 2nd surgical case rate, choose the surgical procedure then click the 2nd checkbox to
assign the Second Case Rate. Click Close when done.

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18. Back to Diagnosis/Case Rate tab, noticed that assigned case rate amount on the surgical
procedure will appear on Case Rate Details.

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Medical and Surgical Case Rate

19. If the patients case rate are both Medical and Surgical, select the ICD 10 Code for Medical
and Surgical Case Rates on the PhilHealth Details > Diagnosis/Case Rates > Final
Diagnosis. If the medical case rate is the Primary Diagnosis, click the 1st column checkbox
and the First Case Rate checkbox. Then, click the Post button.

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20. Back to the PhilHealth Details window, the amount of the chosen Case Rate will appear on
the Case Rate Details.

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21. Then proceed to the Physicians and Services tab. Click the button on the 1st column to choose
the surgical procedure.

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22. After choosing the surgical procedure, if you click the First Case Rate button, a System Alert
will appear prompting that the First Case Rate is already defined.

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23. Back to the Case Rate Details, the amount of the chosen Case Rate will appear on the Case
Rate Details.

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24. For the Professional Fee, if there are two or more doctors, note that the system automatically
distributes the PF amount equally. In case that one doctor should have higher PF, user may opt to
edit the amount by enabling the setup Enable Professional Fee Amount to be covered by
Philhealth in Setup and Options module.

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Special Cases
25. If the Case Rate has Special Package, you may set this in eClaims Case Rate > PhilHealth
eClaims Case Rate Details then select the assigned Package.

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26. The setup for selected package will be enabled on Philhealth Details > Special
Considerations > other Special Package.

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27. If the patient has outside charges, user may input them in Medicines Outside Charges and
Examinations Outside Charges fields found in Computation Table tab.

28. Proceed with the other process then if done, click the Save and Close button.

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29. The PhilHealth Benefits will appear to the patients SOA.

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Claim Form 2 Printing

1. On the Outright Deduction, click Print Claim Forms. On the PhilHealth Claims Reports
window, select the Claim Form 2 for 2013 First Page then click the Preview button.

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Medical Case Rate 1st page

2. Here is the preview of the new CF2 report (front)
a. for Medical Case Rate 1st page:

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Part I Health Care Institution (HCI) Information

1. PhilHealth Accreditation Number (PAN) if Health Care Institution Global Settings
> Philhealth (PHIC) Settings > Accreditation
2. Name of Health Care Institution Global Settings > Hospital Name
3. Address Global Settings > Complete Address
Part II Patient Confinement Information
1. Name of Patient patient registration
2. Was patient referred by another Health Care Institution (HCI)? Patient
Registration Referred From > Other Hospitals

3. Confinement Period patients Admission Date and Time and Discharge Date and Time
4. Patient Disposition - May Go Home Disposition (Please assign in PHIC Disposition Code
in Tables.Templates > Disposition Types)
5. Type of Accommodation patients Admission Case Type
6. Admission Diagnosis/es - Inputted Initial Impression when tagging May Go Home
7. Discharge Dianosis/es - Inputted Discharge Diagnosis in HIS/PHIC Post Final Diagnosis

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8. Special Considerations - Repetitive Procedures in Patient Registration

9. Philhealth Benefits assigned patient Case Rate

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Medical Case Rate 2nd Page

b. Here is the preview of the new CF2 report 2nd Page for Medical Case Rate:

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Details:
10. Professional Fees / Charges Doctors Accreditation Number and PHIC Doctor Fee
Part III Certification of Consumption of Benefits and Consent to Access Patient
Records/s
A. Certification of Consumption of Benefits PHIC Deduction Details

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Surgical Case Rate CF2 1st Page

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Surgical Case Rate CF2 2nd Page

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Both Medical and Surgical Case Rate CF2 1st Page

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Both Medical and Surgical Case Rate CF2 2nd Page

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CF2 1st Page (with Outside charges)

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