PHILHEALTH HCI Portal: Benefit Availment Made Easier

Yes or No?

This simple question can mean a lot of things, but for PhilHealth accredited health care providers with Health Care Institution Portal, a YES signifies only one thing – easier, faster, hassle-free availment of benefits for PhilHealth members and their dependents confined in their facilities.

Last year, PhilHealth required its accredited health care institutions to install the HCI Portal. Serving as the electronic gateway, the HCI portal simplifies filing of PhilHealth claims and availment procedures by reducing documentary requirements. The PhilHealth Benefit Eligibility Form (PBEF) which the portal generates, effectively replaces the Member Data Record, and ascertains the eligibility of the member or his dependent to avail of the benefits at point-of-service.

How does the HCI portal work?

With a reliable internet connection, the HCIs can access a member’s records through the PhilHealth Benefit Verification Module. Immediately, they can check if a dependent is qualified to avail of the benefits, if a member has sufficient premium contributions, or even verify the membership category to which the member belongs.

Once a patient is admitted for confinement, a hospital staff member will ask the patient for vital information related to PhilHealth membership. If the PhilHealth Identification Number is not available, the patient may give his full name and birth date, the hospital staff member will key in the given information in the portal and verify the following: PhilHealth membership or dependency, premium contribution and compliance to the 45 days benefit limit. Once the portal yields a YES for an answer, the patient is eligible to avail of PhilHealth benefits for the said confinement.

If the portal says NO, that doesn’t mean that the patient is denied of his privilege to enjoy his PhilHealth benefits. He will be asked to provide the PhilHealth Claim Form 1, MDR and proof of dependency for qualified dependents. These documents shall be attached to the PBEF and will be submitted to PhilHealth once the hospital files for claim reimbursements.

The implementation of the HCI portal and PBEF also impacts greatly on PhilHealth’s operations. Non-requirement of MDR means less requests for printing, which translates to lesser member queues and savings in logistics and manpower in the Local Health Insurance Offices.

“PhilHealth is committed to improving its business processes. I always reiterate that PhilHealth members are our primary and priority concern. With the implementation of the PBEF from the HCI portal we are making benefit availment more convenient for our members,” said Alexander A. Padilla, PhilHealth President and CEO.

With eligibility checking already transferred to the hospital, the procedure somehow gives HCIs some form of assurance that the claimant is indeed eligible to be entitled to the health care benefits, since the transaction was already approved by PhilHealth through the PBEF.

It also means faster claims processing, and since updates on new policies such as circulars and advisories are being disseminated through the HCI portal, it also serves as the hospital’s information source.

“PhilHealth values its partnership with the healthcare providers. Now that the HCI portal is in place, we are looking forward to an even more transparent and harmonious relationship with them,” added Padilla.(END) (Pinky G. Aragones)