Hospital Systems 8
PhilHealth Information Systems
PhilHealth Circular 2024-0033
Outpatient Emergency Care Benefit Package
This circular covers all outpatient services and commodities, provided in
PhilHealth-accredited healthcare facilities and rendered at the Emergency
Department including its extension facilities. This includes, health services as
well as commodities provided prior to arrival, or during transport to a
healthcare facility. However, shall not include:
1. Emergency services provided outside the ED or its extension facilities
2. Emergency services and commodities included in existing packages
3. Prehospital emergency services provided at home
4. Emergency services provided to patients who are for admission into a
healthcare facility
PhilHealth Circular 2024-0033
Things to Consider for OECB
• OECB does not follow the current working of All-Case-Rate (ACR). There is
no floor or ceiling when it comes to the amount that can be claimed. It is
dependent on what has been rendered to the patient as long as it is
included in the list of compensable items and services.
• Only one ED Consultation can be charged to the patient, depending on how
critical the case is you can either select between Emergent & Urgent
• Incentives for Downward Referral can be claimed for eKonsulta Referral of
patients not yet registered to any facility
• Selling price for Items and Services should not be below the prescribed
Fixed Fee amount by the PhilHealth.
PhilHealth Circular 2024-0033
Things to Consider for OECB
• Although it is stated in the circular that computation of discount should be
based on the remaining amount after PhilHealth coverage has been
deducted, this has been overturned by PhilHealth Advisory 2025-0017
stating that mandatory discounts should first be computed prior to
deducting PhilHealth coverage.
• Only OPER1 is for implementation, OPER2 is on hold pending additional
updates from PhilHealth
Prerequisites
Hospital Systems 8
Version
• This feature is available in [Link] exe
version and later
Feature Configuration
Enabling System Setup
• PhilHealth Information System
• Set “Enable New Case Rate Amount
Buildup” to “Yes” (Started
[Link])
• Set the value for “Mode of Claims
Processing” to "Both FFS and
Packages" (Case Rate and OECB)
• Hospital Information System
• Set "Enable Fee for Service Coverage
Limit Per Item and Services" to “Yes”
Note: After completing the setup configuration, please ensure that
both the HIS and PIS applications are restarted.
Feature Configuration
Reviewing System
Templates
• PhilHealth Information System
• Check the buildup for eClaims Case
Rates for:
CR4750 - FACILITY-BASED EMERGENCY (FBE)
BENEFIT THAT COVERS ESSENTIAL
OUTPATIENT SERVICES AND COMMODITIES
PROVIDED IN AN EMERGENCY DEPARTMENT
(ED) AND ITS EXTENSION FACILITIES
• Set the value for Mode of Deduction
to “Fee for Service”
• Leave the Hospital and Professional
Fee Amount as zero
Feature Configuration
Reviewing System
Templates
• PhilHealth Information System
• Ensure that there is an existing
Surgical Procedure for:
OPER1 - FACILITY-BASED EMERGENCY (FBE)
BENEFIT THAT COVERS ESSENTIAL
OUTPATIENT SERVICES AND COMMODITIES
PROVIDED IN AN EMERGENCY DEPARTMENT
(ED) AND ITS EXTENSION FACILITIES
• Assign OPER1 as RVS code
• Leave the Hospital and Professional
Fee Amount as zero
Feature Configuration
Reviewing System
Templates
• PhilHealth Information System
• Review if PhilHealth Price Item under
Tables and Templates has been
populated
• If Yes, then proceed to Item
Mapping
• If No, you can download the script
to populate the PhilHealth item
price from mediafire and execute it
(OECB Price Item scripts_rev)
Items and Services Mapping
Assigning Fixed Fee to OECB
items
• Once all the required buildup is in place, go
to the Items and Services buildup under
the Hospital Information System App,
locate the item allowed to be part of the
claim for OPER1 and edit the record
• A new tab labelled “PhilHealth Coverage”
should appear. It is here where you will
need to define the equivalent Fixed Fee
from the list provided by PhilHealth
• If the tab does not appear, check the NHIP
Compensable checkbox, click Save and
Close, then edit the record once again, the
said tab will now appear
Items and Services Mapping
Assigning Fixed Fee List to
Hospital Buildup
• Proceed to the PhilHealth Coverage tab, the
Package OPER1 should appear (this list is
triggered by setting the eClaims Case Rate
mode of deduction to Fee for Service)
• Tick the checkbox on the left side if this item
is supposed to be included for the OECB claim
• Define the Fixed Fee under the Amount
column
• Set the Discount order to Before (in
compliance to PA 2025-0017 overruling a
requirement defined under PC 2024-0033)
• Select the equivalent EECL Description for this
item
Items and Services Mapping
Validating Charge Price
• In compliance to the Benefit Availment
instruction #6, a validation function has
been incorporated in the mapping page. This
will check your existing price structure to
ensure that there are no items that will be
sold below the defined fixed fee by the
PhilHealth
• In there such items, it is recommended that
the item price should be changed to
something equal or higher than the
defined fixed fee
PhilHealth Circular
2024-0033
Claims Processing
• Because of the PhilHealth Advisory 2025-0017,
there will be no change as to the workflow
when processing OECB claims. It will still follow
existing standard billing process
1. Charging of Hospital Charges
2. Posting of Mandatory Discount (Senior
Citizen or PWD) if applicable
3. Posting of PhilHealth Benefits
Deductions
4. Posting of Other Discounts or HMO
5. Posting of Payments
6. Posting of Promissory Notes if
applicable
PhilHealth Circular 2024-
0033
New Documentation
Requirement
• As part of the requirements set by
PhilHealth, the Essential Emergency Care
List (EECL) Summary form must be
included in the documents to be
submitted.
• This is also part of the new forms available
for population and printing under the Print
Claim Forms under the Sub-Components
of Outright Deduction
PhilHealth Circular 2024-
0033
New Documentation
Requirement
• Since most of the data is available, only the following
is needed to be populated:
• Triage Level
1 - Resuscitative
2 – Critical/Emergent
3 – Acute/Urgent
4 – Less Urgent
5 – Non-Urgent
• Chief Complaint Category
• Once accomplished, save the record and then it
will be available for printing and must be duly
signed before scanning for purpose of
PhilHealth Circular 2024-0033
New Document
• Click the Preview Button for EECL form
• Use the “Essential Emergency Care
List(EECL) Summary” with the Document
Type Code “ECL” when uploading
this document
Hospital Systems 8
PhilHealth Information Systems
Case Rates Amount
Effectivity Date
THANK YOU
[Link]
