Checklist of Requirements for Ihcps Engaging With Philhealth

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  • 8/13/2019 Checklist of Requirements for Ihcps Engaging With Philhealth

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    CHECKLIST OF REQUIREMENTS for IHCPs

    ASIC PARTICIPATION (Initial)____ Performance Commitment____ Providers Data Record____ Participation fee____ Latest audited financial statement/report____ Electronic copies of recent photo of the facility____ Statement of Intent (for last quarter application)

    DDITIONAL REQUIREMENT for BASIC PARTICIPATIONOSPITAL ASC FDC

    ___ D! License "ith validity applica#le to the en$a$ement periodplied for%___ D! Licenses for & previous years or its re'uired alternative

    document (PC !"s !##$) for initial en$a$ement of licensed I!CPs

    D%ANCED PARTICIPATION&&&&& Letter of Intent for dvanced Participation_____ ccomplished Selfssessment tool for dvanced Participationertified #y

    I)"ith passin$ score%_______ *inancial Ris+ Protection ,odule_______ -uality !ealth Care ,odule

    _____ dvanced Participation *ee

    E'ISTRATION FEEINSTITUTION INITIAL

    (Priat 'orn*nt)

    Ann+al

    Parti,i-ationf

    SC .000%00 1000%00

    (*DC) !D 2 PD .000%00 .000%00

    PC3 4000%00 4000%00

    53 D5S 4000%00 4000%00

    ,CP 4.00%00 4000%00

    PC3/,CP/53D5S

    4000%00 4000%00

    PC3 / 53 D5S 4000%00 4000%00

    PC3/ ,CP 4.00%00 4.00%00

    ,CP/ 53 D5S 4.00%00 4.00%00

    3P 4000%00 4000%00

    LE6EL 4 !ospital / Infirmary(& yearsmoratorium)

    &000%00

    LE6EL II !ospital .000%00

    LE6EL II !ospital 7000%00

    LE6EL III !ospitals (5eachin$ !ospital) 40000%00

    LE6EL I6 !ospital ( under & yearsmoratorium)

    40000%00

    ONTINUOUS PARTICIPATION&&&& Providers Data Record____ 8pdated D! License____ Performance Commitment____ Updated Certificates issued by DOH/CHD or any 3 party

    Accrediting body duly recognized by Philhealth.( if applicable____ Latest udited *inancial Statement____ Proof of payment of the participation fee%

    DDITIONAL REQUIREMENT FOR CONTINUOUSARTICIPATION____ electronic copy photo of facility if "ith chan$es (include date ta+en)____ Certificate as 9e"#orn Screenin$ *acility (for hospitals only)____ vaila#ility of Internet Connection/ I!CP Portal .ES

    O(If No/ as0 for ,rtifi,ation of non aaila1ilit2 of intrnt -roi3r in t4 ara)

    ____ 8pdated copy of R* 4 (as reference for list of personnel)____ r$ani:ational Chart

    RIMAR. CARE BENEFIT " PRO%IDER&&& MOA"ith referral facility ; if applica#le___ Location map (to validate veracity)___ Tr+st F+n3( certified #y the Local ccountin$ fficer as per PCs

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    CHECKLIST OF REQUIREMENTSPR6IDER PR*ILE 8PD5E (RECCREDI55I9)

    As per Philhealth Circular 11,s. 2013

    "7 8it4 'AP 5it43ra5n fro* a,,r3itation!7 Transfr of lo,ation97 A33itional sri,:7 Rs+*-tion of o-ration;7 U-6ra3in6 of Ll7 C4an6 of o5nrs4i- ( A$C/!DC/Hospitals______ Letter re'uest______ Proof of chan$e in o"nership (eg. !C, "ee# of ale, "$% Certificate)

    $7 C4an6 of o5nrs4i- ( for pri%ate &CP' ) DO$' A)PP&&&&&& ,ayors Permit

    RE'ISTRATION FEEINSTITUTION INITIAL

    (Priat 'orn*nt)

    Ann+alParti,i-ation

    f

    SC .000%00 1000%00(*DC) !D 2 PD .000%00 .000%00

    PC3 4000%00 4000%00

    53 D5S 4000%00 4000%00

    ,CP 4.00%00 4000%00

    PC3/,CP/53D5S

    4000%00 4000%00

    PC3 / 53 D5S 4000%00 4000%00

    PC3/ ,CP 4.00%00 4.00%00

    ,CP/ 53 D5S 4.00%00 4.00%00

    3P 4000%00 4000%00

    LE6EL 4 !ospital / Infirmary(& yearsmoratorium)

    &000%00

    LE6EL II !ospital .000%00

    LE6EL II !ospital 7000%00

    LE6EL III !ospitals (5eachin$ !ospital) 40000%00

    CHECKLIST OF REQUIREMENTSPR6IDER PR*ILE 8PD5E (RECCREDI55I9)

    As per Philhealth Circular 11,s. 2013

    "7 8it4 'AP 5it43ra5n fro* a,,r3itation!7 Transfr of lo,ation97 A33itional sri,:7 Rs+*-tion of o-ration;7 U-6ra3in6 of Ll7 C4an6 of o5nrs4i- ( A$C/!DC/Hospitals______ Letter re'uest______ Proof of chan$e in o"nership (eg. !C, "ee# of ale, "$% Certificate)

    $7 C4an6 of o5nrs4i- ( for pri%ate &CP' ) DO$' A)PP&&&&&& ,ayors Permit

    RE'ISTRATION FEEINSTITUTION INITIAL

    (Priat 'orn*nt)

    Ann+alParti,i-ation

    f

    SC .000%00 1000%00

    (*DC) !D 2 PD .000%00 .000%00

    PC3 4000%00 4000%00

    53 D5S 4000%00 4000%00

    ,CP 4.00%00 4000%00PC3/,CP/53D5S

    4000%00 4000%00

    PC3 / 53 D5S 4000%00 4000%00

    PC3/ ,CP 4.00%00 4.00%00

    ,CP/ 53 D5S 4.00%00 4.00%00

    3P 4000%00 4000%00

    LE6EL 4 !ospital / Infirmary(& yearsmoratorium)

    &000%00

    LE6EL II !ospital .000%00

    LE6EL II !ospital 7000%00

    LE6EL III !os itals 5eachin !os ital 40 000%00

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    CHECKLIST OF REQUIREMENTSCCREDI55I9 * !EL5! CRE PR*ESSSI9LS

    s per PC .. s% 4 recent pictureo ____ photocopy of PRC license or its e'uivalent

    o ____ photocopy of 5I9 card

    o ____ affidavit of s"orn declaration of current

    $ross income (with pri&ate practice ' for ta(up#ating)

    o ____ service record

    o ____ appointment paper

    #eneral Practitioner *ith raining+o same as a#ove plus?%

    o ____ Completed Residency 5rainin$ Certificate%

    &edical $pecialist+o ____ Specialty 3oard Certificate

    II ? 'orn*nt ? RENE8AL

    #eneral Practitioner/ &edical $pecialist / Dentist /&id*ife

    CHECKLIST OF REQUIREMENTSCCREDI55I9 * !EL5! CRE PR*ESSSI9LS

    s per PC .. s%