Republic ofthe Philippines PHILIPPINE HEALTH INSURANCE CORPORATION CCitystate Centre, 709 Shaw Boalevard, Pasig City {Cal Center: (02) 8861-7442 | Trane: (02) 841-7484, ‘ru plheth Bov ph PHILHEALTH CIRCULAR No_2020 - 0004 TO + ALL ACCREDITED HEALTH CARE PROVIDERS AND ALL OTHERS CONCERNED SUBJECT : Benefit inpat firmed I, BACKGROUND/RATIONALE ‘On March 11, 2020, the World Health Organization (WHO) declared a global pandemic of the Coronavirus Disease 2019 (COVID-19). Subsequently Presidential Proclamation No. 929 s. 2020 was issued declaring a State of Calsmity throughout the Philippines due to the increasing number of individuals infected with the virus. The entire Luzon was also placed under Enhanced Community Quarantine (ECQ) on March 16, 2020 to prevent virus transmission. ‘The response of the national government to this global pandemic was the legislation of Republic Act (RA) No. 11469 or the Baysnihan to Heal as One Act. This law envisioned a coordinated whole-of-government and whole-of-society approach to eradicate COVID-19. Under the Universal Health Care Act (RA 11223), PhilFcalth shall ensure equitable access to quality, affordable and accessible health care se-sices by all Filipinos. By providing coverage for inpatient care of probable and confirmed COVID-19 developing severe illness /outcomes, PhilHealth, through PhilHealth Board Resolution No. 2516 s. 2020, shall cover the comprehensive case management for COVID-19. OBJECTIVE ‘This circular sims to establish the guidelines for the implementation of COVID-19 benefits for inpatient care for patients with probable or confirmed cases, SCOPE This circular shall apply to all Filipinos confined 2s probable or confirmed cases of COVID-19 and all PhilHealth accredited healthenre providers with capacity to provide inpatient case management for these. QPrHeatroteel QOaronineatn sctoncetaraptneaknoovehIV. DEFINITION OF TERMS' A. Suspect case — is « person who is presenting with any of the following conditions: 1. All severe acute respiratory infection (SARI) cases where no other etiology fully explains the clinical presentation; 2. Influenza-like illness (ILI) cases with any one of the following: 2. With no other etiology that filly explains the clinical presentation and a history of teavel to or residence in an area that reported local transmission of COVID- 19 disease during the 14 days prior to symptom onset; or b. With contact to a confirmed or provable case of COVID-19 disease during the 14 days prior to the onset of symptoms 3. Individuals with fever ot cough ot shortness of breath or other respiratory signs or symptoms fulfilling any one of the following conditions: a. Aged 60 years and above b. With a comorbidity c. Assessed as having a high-risk pregnancy d. Health worker B. Probable case ~ a suspect case who fulfills any one of the following listed below: 41. Suspect case whom laboratory testing for COVID-19 is inconclusive; or 2 Suspect who underwent testing for COVID-19 but not conducted in a national oz subnational reference laboratory or officially accredited laboratory for COVID-19 confirmatory testing; or 3. Suspect case for which testing could not be performed for any reason. C. Confirmed case — any individual, irrespective of presence or absence of clinical signs and symptoms, who was lnbotatory-confirmed for COVID-19 in a test conducted at the national reference laboratory, a subnational reference laboratory, and/or offically accredited laboratory testing facili | Philippine Society for Miesobiology and Infectious Disease, Intesim guidelines on the clinical management of adulepatients with suspected or confirmed COVID-19 infections version 21 25 of 31 March QP eatrotcel OO werohneath @ actoncenerastinesttgovehq : V. GENERAL GUIDELINES A. All Filipinos shall be deemed eligible for any of the COVID-19 benefits for inpatient care. Filipinos who are not registered in PhilFfealth shall be automatically covered, provided that they complete member registration prior to discharge from the facility; B. The single petiod of confinement and 45 days annual benefit limit shall not be applied in this benefit package; . All COVID-19 benefits for inpatient care shall have no co-payment from the patient for direct healtheare services, both in private and public healthcare providers. Patients can have co-payments for amenities such as suite room accommodation; 9 Data sharing of suspect, probable, and confirmed cases of COVID-19 shall be done between the DOH and PhilHfealth to develop a comprehensive patient registry in accordance with the Data Privacy Act of 2012; E. All items donated by third parties shall not he -harged to the patient. VI. BENEFIT AVAILMENT A. The case-based payment of the benefits that shall be available for any Filipino patient with probable or confirmed COVID-19 are indicated in Table 1: ‘Table 1. Inpatient case management for confirmed COVID-19 developing severe illness or Package Package Severity HCP Category Code amount (PHP) cist 43,997" Mild pneumonia in che " L1 to L3 hospital, private room elderly of with co- morbidities cise 143,267 "Moderate pneumonia" L1 to L3 hospital, private room cies 333,519 "Severe pneumonia" L.2 to L3 hospital, private zoom, ICU C191P4 786,384 Critical pneumonia ‘12 to L3 hospital, private zoom, ICU (capable of ECMO, RR) @Privicathorct (YO tsorhinooth @ actoncontorgphiesthgovehB. To ensure provider capability, levels 2 and 3 (L2, L3) health care providers (HCPs) shall be tagged in the integrated PhilHealth Accreditation System ((PAS) as providers of services for severe and critical pneumonia packages. L1 HCPs can only provide services for mild pneumonia package, except when there are 20 other higher level of facilities that can accommodate the surge of patients within an area for the inpatient case management of ‘moderate pneumonia; C. For critical pneumonia, additional necessary medical services for cases that develop or ‘with impending severe illness, which include, but ace not limited to the folowing, shall be covered by this benefit package: Acute respiratory distress syndrome (ARDS) Septic shock Requiring invasive ventilation Requiring extracorporeal membrane oxygenation (ECMO). HCPs with the necessary equipment for ECMO shall be identified and tagged by PhilFlealth. 5. Requiring renal replacement therapy (RRT) aeRe D. The following are the mandatory services included in these benefit packages, inclusive of professional/readers? fees: Accommodation ‘Management and monitoring of illness Laboratory/diagnostics/imaging 4, Medicines that are included in the guidelines and protocols of the DOH. 5. Supplies and equipment (including personal protective equipment) ‘Vil. CLAIMS FILING AND REIMBURSEMENT ‘The following are the rules for claims filing and reimbursement: ‘A, All dlaims shall be filed by the accredited healthcare provider. There shall be no direct filing by the PhilHealth member, B. Claims for testing for SARS-CoV-2 shall be filed separately; C. The basis for payment shall be the package code which shall be indicated in item 8b of ‘Claim Form 2 (CF2); D. For statistical purposes and in accordance with the DOH guidelines, health care providers should indicate the corresponding ICD-10 codes of probable and confirmed COVID-19 patients availing of these benefit packages in item 7 of CF2. Further, ICD-10 codes of all comorbidities shall also be indicated in item 7 of CF2; QrritHostnetcat GO touretshoutn @acionceterephiheathgovehE. All procedures done duting inpatient case management of probable and confirmed COVID-19 patients shall likewise be indicated in item 7 of CF2; F. For patients referred and transferred from one facility to another upon confirmation of COVID-19, referring facilities shall be allowed to file claims based on the working diagnosis prior to transfer. Likewise, referral facilities may claim for the appropriate benefit package based on the final diagnosis upon discharge; G. Claims shall be filed within 60 calendar days upon discharge of the patients. Rules on late filing of claims shall apply, HL To file 2 claim for reimbursement, the accredited healthcare provider shall submit the following documents to PhilHeulth: 1. Properly accomplished CF2 2. Itemized billing statement, including profeessional/readers’ fees, The process flow for submission of itemized billing statements is described in Annex “A”. 3. Properly accomplished PhilHealth Member Registration Form (PMRF) for untegistered PhilFealth members, or updated PMRF, as needed 1. All mandatory deductions as provided by law, such as, but aot limited to senior citizen discounts, PWD discounts, etc. shall be deducted first from the total hospital bill of the patient. All other health benefits such as, but not limited to, health maintenance organizations (FIMOs), private health insurance (PHIs), and employee discounts shall complement the benefit packages of PhilHealth as stipulated in this circular. All the above deductions and benefits shall be reflected in the itemized billing statement of the patients; J. Claims with incomplete requirements/discrepancy/ies shall be returned to sender (RTS) for compliance within 60 calendar days from zeceipt of notice; Claims applications shall be processed by PhilHlealth within the prescribed filing period provided thavall requirements are complied with; If the delay in filing of claims is due to natural calamities, or other fortuitous events, the accredited healthcare provider shall be accorded 120 calendar days as stipulated in Item V, Section G.t of PhilHealth Circular No. 2020-0007. @ @ Prineatortciat © Oreorontneatn @acionceteraprineain govohVIII. MONITORING A. The monitoring of the implementation of these benefit packages shall be in accordance ‘with current monitoring rules and guidelines of PhilHealth and other relevant policies of the DOH; B. Performance indicators and measures to monitor compliance to the policy and standards of cate shall be established in collaboration with relevant stakeholders and experts; CC. Random and post- audits shall be conducted upon implementation of this policy. IX. POLICY REVIEW Regular policy review of the benefits for COVID-19 inpatient case management shall be conducted as needed in collaboration with a multiisciplinary team of experts and relevant stakeholders and technical representatives in the Corporation in consideration of updates in guidelines, protocols, and costing. X, REPEALING CLAUSE ‘This cepeals PhilHealth Circular No. 2020-0004 entitled “Enhancement of packages related to Coronavirus Infection.” XI. EFFECTIVITY ‘This Circular shall be published in a newspaper of general circulation and deposited with the National Administrative Register, University of the Philippines Law Center. This shall take effect forall admission dates beginning 15 April 2020. LIST OF ANNEX Annex “A” - Process flow for the submission of itemized billing statements © BGEN RI C. MORALES, AFP (RET) FICD¢#- President and Chief Executive Officer w Date___* isa) © @rrneatocat GO warehneath @ocioncarerGphineath gownoft Pins EB = Repablic 3 PHILIPPINE HEALTH INSURANCE CORPORATION i ‘Citytate Cerite, 709 Shaw Bowlevar, Pasig City (Call Gener: (2) 8441-7449 | Truskine(02) 8401-7464 swore phitheat. gov ph PHILHEALTH CIRCULAR No. 2020- 0010 To 2 ALL ACCREDITED HEALTH CARE PROVIDERS, ACCREDITED SARS-CoV-2 TESTING LABORATORIES AND ALL OTHERS CONCERNED SUBJECT : Benefit CoV I, BACKGROUND/RATIONALE ‘On March 11, 2020, the World Health Organization (WHO) declared a global pandemic of the Coronavirus Disease 2019 (COVID-19). Subsequently Presidential Proclamation No. 929 s. 2020 was issued declaring a State of Calamity throughout the Philippines duc to the increasing number of individuals infected with the virus. The entire Luzon was also placed under Enhanced Community Quarantine (ECQ) on March 16, 2020 to prevent virus transmission. The response of the national government to this global pandemic was the legislation of Republic Act No. 11469 or the Bayanihan to Heal as One Act. This law envisioned a coordinated whole-of government and whole-of-society approach to eradicate COVID-19. Under the Universal Health Care Act (RA 11223), PhilHealth shall ensure equitable access to quality, affordable and accessible health cate services by all Filipinos. By providing coverage for diagnostic tests, PhilHTealth, through PhilHealth Board Resolution No. 2516 s. 2020, shall cover the medical expenses for testing of SARS-CoV-2. U. OBJECTIVE ‘This circular aims to establish the policy for the implementation of the benefit package for the testing for SARS-CoV-2. SCOPE This circular shall apply to all Filipinos tested for SARS-CoV-2, to the Research Institute for ‘Tropical Medicine-Department of Health (RITM-DOH), and to all testing laboratories that are certified by RITM-DOH, MINIMUM STANDARDS A. All RITM-DOH cextified testing laboratories for SARS-CoV-2 that have the capacity to adhere to the following established standards and accepted protocols shall be accredited by PhilFfealth to provide the following services: 1. Conduct of real time - polymerase chain reaction (RT-PCR) testing 2. Analysis and reporting of results, @ rience! EPO tosrnohibuatn @ sctoncateraphineathgouehB. Testing laboratories shall submit their official certification from the RITM-DOH to become accredited by PhilHealth for this benefit package. V. BENEFIT AVAILMENT A. All Filipinos who are classified as eligible for testing based on DOH guidelines, as well as all COVID-19 cases that require repeated testing can avail of the benefit package. Filipinos who are not registered in PhilHealth shall be automatically covered, provided that they complete member registration upon availment of the benefit package; B. The single period of confinement and 45 days annual benefit limit shall not be applied in this benefit package; C. Accredited testing laboratories are required to have an electronic health record of all patients who underwent the SARS-CoV-2 testing, Tf this is not available, a manual record of patients who underwent the SARS-CoV 2 testing shall be acceptable during the state of emergency D. The services inchided in this benefit package are the following : Screening/clinical assessment ‘Diagnostic workup, as indicated Specimen collection Specimen transport Conduct of RT-PCR testing (including the test kit) Analysis and reporting of results ayaenye E. The case-based payment of the benefits for testing for SARS-CoV-2 that shall be available for any Filipino patient are indicated in Table 1. The testing laboratory accredited by PhilHlealth and listed in the accreditation database may claim one of the following packages: ‘Table 1. Packages for SARS-CoV-2 testing Package Description® Package Code Amount (Php) r i 7 1 C19T1 All seevices for the testing are procured and provided by 8,150 the testing laboratory C19T2 Test kits are donated to the testing laboratory 5,450 C19T3 Test kits are donated to the testing laboratory; cost of 2.710 sunning the laboratory and the RT-PCR machine for testing is included in the facility budget "Requies tagging in the integrated PhilFlealth accreditation system (PAS) Qrrineathottcat GOreameninestn @actoncenerephiheath coupF. PhilFealth shall pay the package amount for all services rendered by the SARS-CoV-2. testing laboratories; 1. The accredited testing laboratory shall establish or develop internal guidelines and process regarding transfer of corresponding payments to refesring facilities for payment of screening, collection and transport of specimens. 2 The accredited testing laboratories shall establish referral agreement with the referring facility for the following services a) Screening / clinical assessment b) Diagnostic work-up 9) Specimen collection ©) Specimen transport G. Patients shall not be charged co-payment for sezvices received for the test for SARS-CoV-2, H. The benefit package shall be updated as needed to reflect current protocols and standards in collaboration with relevant instications, experts, and stakeholders. ‘VI. CLAIMS FILING AND REIMBURSEMENT A. Claims applications for this benefit package for SARS-CoV-2 testing shall be filed separately from other COVID-19 claims, B. While claims submission is not yet fully automated, manual filing of claims shall be acceptable; p ‘There shall be no direct filing of claims for SARS-CoV-2 testing by members except for tests conducted during the petiod of 1 February 2020 to 14 April 2020; D. Requirements for claims applications include the following documents: 1. Properly accomplished Claim Form 2 (CF2) 2. Cetfied true copy of Case Investigation Form (CIF) that is prescribed by the DOH 3. Official receipts are required for ditectly filed claims for tests conducted during the period of 1 February 2020 to 14 Apsil 2020. E. Claims for multiple testing of samples of a patient may be filed in one Claim Form 2; F. All claims for the testing for SARS-CoV-2 must be fled within 60 calendar days from receipt of the specimen by the testing laboratory. Rules on late filing shall apply; @Privieaenortcat EO worehinesth @actonceneargphineathsovehH. If the delzy in the filing of claims is due to natural calamities or other fortuitous events, 120 calendar days shall be accorded as stipulated in Item V, Section G.1 of PhilHlealth Circular No. 2020-0007; . All claims applications shall have complete attachments as required in the policys Claims applications shall be processed by vhilHealth within the prescribed filing period provided that all requirements are complied with. 1. Claims for SARS-CoV-2 Testing package shall be filed with special tagging in the accreditation system for this purpose; 2. All claims for SARS-CoV-2 testing shall be paid directly to the accredited SARS-CoV-2 testing laboratory except for claims that were directly filed to PhilHealth by members; ‘All mandatory deduetions as provided by law, such as, but not limited to senior citizen discounts, PWD discounts, etc. shall be deducted first from the total hospital bill of the patient, All other health benefits such as, but not limited to, health maintenance organizations (HMOs), private health insurance (PHIs), and employee discounts shall complement the benefit packages of PhilHealth as stipulated in this, circular. All the above deductions and benefits shall be reflected in the itemized billing statement of the patients; 4, Claims with incomplete requirements,’ usctepancy/ies shall be retumed to sender (RTS) for compliance within 60 calendar days from receipt of notice. Vil. MONITORING A. Alll accredited SARS-CoV-2 testing laboratories claiming for this benefit package shall be subject to the sules on monitoring set by PhilHealth. For tagging the iPAS, PhilFlealth shall secure from the DOH the distribution list of all testing laboratories with donated test Kits ae well as those laboratories with operation costs funded by the government co un the RT-PCR test; Copies of referral agreements shall be maintained by the testing laboratories and such documents shall be made available to PhilHealth authorized personnel at all times; Feedback mechanisms shall be established to monitor implementation issues and concerns; .. PhifFfealth shall coordinate with DOH for data sharing on the list of patients availing of the SARS-CoV-2 ‘Testing, PhilHealth should eventually develop its own registry for facilities accredited by PhilFealth for SARS-CoV-2 testing, @rivestrortcat QO teoretineatn @actoncertereptihasthigovehVill. EFFECTIVITY ‘This Circular shall take effect immediately with retroactive coverage for all qualified SARS- CoV-2 tests conducted in RITM, RITM-DOH certified and accredited laboratories starting 1 February 2020. ‘This shall be published in 2 newspaper of general circulation and shall be deposited with the National Administrative Register, University of the Philippines Law Center. BGEN RI . MORALES, AFP (RET) FIC | - COPY MASTER Qeresnstottetal GO morohtnesth @aconcerterephthesth aovehCCitytate Centre, 709 Shaw Boulevard, Pasig Ciy Call Cote: (02) 4441-7442. | Trankline: (02) 8481-7404 ‘www piealth gov ah ©, Repub of te Pipe i PHILIPPINE HEALTH INSURA}iCE CORPORATION PHILHEALTH CIRCULAR No.2020-00l! TO : ALL ACCREDITED HEALTH CARE PROVIDERS AND ALL OTHERS CONCERNED SUBJECT : Full financial risk protection_for Filipina health workers and patients against coronavirus disease (COVID-19) I. BACKGROUND/RATIONALE ‘On March 11, 2020, the World Health Organization (WHO) declared a global pandemic of the Coronavirus Disease 2019 (COVID-19). Subr-quently Presidential Proclamation No, 929 s. 2020 was issued declaring a State of Calamity throughout the Philippines due to the increasing number of individuals infected with the virus. ‘The entire Luzon was also placed under Enhanced Community Quarantine (ECQ) on March 16, 2020 to prevent virus transmission. The response of the national government to this global pandemic was the legislation of Republic Act (RA) No. 11469 or the Bayanihan to Heal as One Act. This law envisioned a coordinated whole-of-government and whole-of-society approach to eradicate COVID- 19. Under the Universal Health Care Act (RA 11223), PhilHealth, through PhilHealth Board Resolution No. 2516 s. 2020, shall cover the comprehensive case management for COVID-19 and ensure equitable access to quality, affordable and accessible health care services by all Filipinos. OBJECTIVES The objectives of the circular are to establish the following ‘A. Guidelines for the interim coverage of probable and confirmed COVID-19 inpatient case management; B. Coverage of health workers as stipulated in Republic Act No. 11469, otherwise known as the Bayanihan to Health As One Act. SCOPE This circular shall apply to all Filipinos, with attention to health workers, confined for probable or confirmed cases of COVID-19, as well as all PhilHealth accredited healthcare providers with capacity to provide inpatient care management for such cases. GPriveeathortcai CBO teorrentheath @ectoncertergphineathgovohIV. DEFINITION OF TERMS A. Suspect case! — is « petson who is presenting with any of the following conditions: 1. All severe acute respiratory infection (SART) cases where no other etiology fully explains the clinical presentati 2. Influenza-like illness (ILI) cases with any one of the following: 2. With no other etiology that fully explains the clinical presentation and a history of travel to ot residence in an area that reported local transmission of COVID- 19 disease during the 14 days prior to symptom onset; or b. With contact to a confirmed or probable case of COVID-19 disease during the 14 days prior to the onset of symptoms 3. Individuals with fever or cough or shortness of breath or other respiratory signs or symptoms fulfilling any one of the following conditions: Aged 60 years and above With 2 comorbidity “Assessed as having a high-risk pregnancy Health worker aoge B. Probable case —a suspect case who fulfils any one of the following listed below: 1. Suspect case whom laboratory testing for COVID-19 is inconclusive; or 2. Suspect who underwent testing for COVID-19 but not conducted in a national or subnational reference laboratory or officially accredited laboratory for COVID-19 confirmatory testing; or 3. Suspect case for which testing could not be pesformed for any reason. . Confirmed case? ~ any individual, irrespective of presence or absence of clinical signs and symptoms, who was laboratory-confirmed for COVID-19 in a test conducted at the national reference laboratory, a subnational reference laboratory, and/or officially accredited laboratory testing facility Health workers - persons engaged in health and health-related work, regardless of employment status, which include doctors, nurses, allied health professionals, administrative and support personnel in health facilites, utility and security personnel working in health facilities, health volunteers deployed in health facilities and staff and personnel working in government health ag:ncies. | Philippine Society for Microbiology and Infectious Disease, Interim guidelines on the clinical management of adult patients with suspected or confizmed COVID-19 infections version 2.1 as of 31 Masch 2 iia ibid Qrrtneartortcat GO eomchtneath @actoncenterephihoathaovshSPECIFIC GUIDELINES A, All Filipinos confined for COVID-19 from the period of 1 February 2020 to 14 Apzil 2020 shall be deemed eligible for any of the benefits for inpatient care with no co- payment, whether in public or private facility. Filipinos who are not registered in PhilHlealth shall be automatically covered, provided that they complete member registration prior to discharge from the facility; B. Health workers regardless of employment status, confined for COVID-19, beginning 1 February 2020 shall be eligible for the COVID-19 benefits for inpatient case management with no co-payment, whether in public or private facility; C. All staff and personnel working in government health agencies, regardless of employment status, shall be eligible for the same benefits as health workers, D. Fill financial risk protection shall be provided to all public and private health workers for medical expenses or any work-related injury or disease curing the duration of National State of Emergency (RA 11469 Sec. 4e); E, All items donated by third patties shall not be changed to the patient. VI. CLAIMS FILING AND REIMBURSEMENT ‘The following are the rules for claims filing and reimbursement: A. All claims shall be filed by the accredited nealthcare provider. There shall be no direct filing by the PhilHealth member except for claims with admission dates beginning 1 February 2020 until 14 April 2020; . Claims for testing for SARS-CoV-2 shall be filed separately; . The basis for payment shall be the package code of C19FRP which shall be indicated in item 8b of Claim Form 2 (CF2); ). For statistical purposes and in accordance with the DOH guidelines, health care providers should indicate the corresponding ICD-10 codes of probable and confirmed COVID-19 patients availing of this benefit package in item 7 of CF2. Further, ICD-10 codes of all comorbidities shall also be indicated in item 7 of CF2; E. All procedures done duting inpatient case management of COVID-19 patients shall likewise be indicated in item 7 of CF2; @rriveainoricel GO tearchineatn @oconcenteraptineathigovshF. For patients referred and transferred from one facility to another upon confirmation of COVID-19, referring facilities shall be allowed to file claims based on the working diagnosis prior to transfer. Likewise, referral facilities may claim for the appropriate benefit package based on the final diagnosis upon discharge; G. Claims shall be filed within 60 calendar days upon discharge of the patients. Rules on late filing of claims shall apply. If the delay in the filing of claims is due to natural calamities or other fortuitous events, 120 calendar days shall be accorded as stipulated in Item V, Section G.1 of PhilFlealth Citculat No. 2020-0007; H, To file a claim for reimbursement, the acre.dited healthcare provider shall submit the following documents to PhillTealth: 1. Properly accomplished Claim Form 2 (CF2) 2. Itemized billing statement, including professional/readers’ fees. ‘The process flow for submission of itemized billing statement is described in Annex “A”. 3. Official receipts are required for disectly filed claims with admission dates beginning, 1 February 2020 until 14 April 2020 4. Properly accomplished PhilHiealth Member Registration Form (PMRF) for unregistered PhilHJealth members, or updated PMRF, 2s needed 5. Centificate of employment, regardless of employment status, or certificate of appointment of personnel working in health facility, or certification from the health facility for security and utility personnel working in their hospital 6. Certification as health volunteer deployed in 2 health facility from the appropriate authority, such as provincial health officer, municipal health officer, city health officer, chief of hospital or head of agency or authorized representative I. All mandatory deductions as provided by law, such as, but not limited to senior citizen discounts, PWD discounts, etc. and all other health benefits such as, but not limited to, health maintenance organizations (HMOs), private health insurance (PHIs), and employee discounts shall be deducted first from the total hospital bill before the PhilFiealth benefits Alll the above deductions and benefits shall be reflected in the itemized billing statement of the patients; J. Claims with incomplete requirements/disctepancy/ies shall be retumed to sender (RTS) for compliance within 60 calendar days from receipt of notice; K. Payment of claims shall be made by the PhilHealth Regional Office based on billing charges to the patient for admission during the petiod of 1 Februaty to 14 April 2020: Payment shall be guided by the following information: 1. Itemized billing statement of the patient 2. Use of amenities, such as suite room accommodation 3. Charges for non-healthcare related items Qprinteathotcal YO tearrohiectn @ectioncerteranhinesthgovehVI. MONITORING A. The monitoring of the implementation of these benefit packages shall be in accordance ‘with current monitoring rules and guidelines of PhilHlealth and other relevant policies of the DOH; B. Performance indicators and measures to monitor compliance to the policy and standards Of cate shall be established in collaboration with relevant stakeholders and experts; C. Random and post-audits shall be conducted upon implementation of this policy. VII. POLICY REVIEW Regular policy review of the benefits for COVID-19 inpatient case management shall be conducted as needed in collaboration with a multidisciplinary team of experts and relevant stakeholders and technical representatives in the Corporation in consideration of updates in guidelines, protocols, and costing. IX. REPEALING CLAUSE ‘This repeals PhilHealth Circular No. 2020-0004 “Enhancement of packages related to Coronavirus Infection.” EFFECTIVITY ‘This Circular shall take effect immediately with retroactive coverage for all hospital admission dates beginning 1 February 2020. This shall be published in 2 newspaper of general circulation and shall be deposited with the National Administrative Register, University of the Philippines Law Center. LIST OF ANNEX (This Annex shall be uploaded in the PhilHealth website) Annex “A ~ Process flow for the submission of itemized billing starements @rriviatnortcal (JO toarechthoatn @actioncenterepineathgoveh