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What’s up, Doc?

07/ 21/ 2016

Let us remind you on few things.

 

Latest Letters

 

CP Clearance as OP basis for elective surgical cases

26 January 2016

 

All elective surgical cases, including OB and Gynecological, Cardio-Pulmonary (CP) clearances must be done on an Out Patient basis prior to admission.

 

  • PHILHEALTH CIRCULARS

16 February 2016

 

Maxicare shall be strictly enforcing the provisions of the following PhilHealth circulars:

 

PhilHealth Circular 023-2015 (http://www.philhealth.gov.ph/circulars/2015/circ023-2015.pdf)

PhilHealth Circular 034-2015 (http://www.philhealth.gov.ph/circulars/2015/circ034-2015.pdf)

PhilHealth Circular 2016-001 (http://www.philhealth.gov.ph/circulars/2016/circ2016-001.pdf)

PhilHealth Circular 2016-002 (http://www.philhealth.gov.ph/circulars/2016/circ2016-002.pdf)

 

As such, we request that our providers adhere to the provisions of these policies and guidelines. Maxicare will not pay for claims that are in violation of the same.

 

  • Emergency Room (ER) Procedure Availment Protocol

 

Maxicare will not accommodate and cover specialized procedures ( i.e. 2-D Echo, Doppler Ultrasound, CT Scan, MRI, MRA, MRCP, Thyroid Function Tests and their STAT fees, STAT fees for specimen cultures, specimen PCR laboratory requests) requested by ER doctors until case is evaluated and procedure is cleared by our Hospital Plan Coordinator and/or by the Specialist concerned (i.e. Cardiologist, Vascular Surgeon, Neurologist, Urologist, General Surgeon, Orthopedic Surgeon,  Endocrinologist, Infectious Disease Specialist) as the case may be.

 

If ER availment is within office/clinic hours (8AM to 5PM), we recommend that patient, if clinically stable and/or has normal vital signs, be referred to the concerned specialist in the clinic for consult and further clearance for the procedure. If the procedure is not deemed emergent, then this should be prescribed as an elective OP procedure and not as an emergency.

 

For trauma cases with severe injuries (i.e. head injuries with loss of consciousness or decreased sensorium, fractures, blunt injuries to the chest/abdomen), approval for the procedure may no longer be sought prior to the procedure based on the immediate need as assessed by the attending doctor. However, post-approval before patient’s discharge from the ER must still be obtained.

 

[Or separate this ER Protocol.]

 

Others

 

  • We would like to remind you that claims/billings should be submitted to us 30 days for NCR and 60 days for provincial from the date of availment/discharge. Late billings are subject to non-payment.

 

  • If you have new affiliated clinic/hospital, please inform us at medical@maxicare.com.ph so we can guide you with our process and update our system.

 

  • We can electronically deposit your PFs to your bank account through our electronic payment facility/auto credit arrangement facility (ACA). Furthermore, payment notification along with payment details and withholding tax details/CWT (Form 2307) will be sent thru email. If you are not yet enrolled to this, let us know at medical@maxicare.com.ph so we can guide you with our process. [or remove this since there’s a separate document for this]

 

 

  • If you have any concerns or clarifications with Maxicare, you can get to us at medical@maxicare.com.ph. Just let us know your name, and in which specific hospital/clinic you are affiliated or you encountered your concern.

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