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5 PROCESSES OF KONSULTA
Generation of
Authorization
Registration Service Provision
Transaction Code
(ATC)
SAP Generation & Uploading of Data
Payment Record
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REGISTRATION
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OPTIONS IN REGISTERING TO A FACILITY
Self Registration
(Member Portal)
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ASSISTED REGISTRATION TO A FACILITY
PhilHealth Local Health Insurance
Office (LHIO) 1 Fill-out the PhilHealth Konsulta
Registration Form
Local Government Unit (LGU)
or Office for Senior Citizens Affairs The assisting office shall:
(OSCA) ✔ generate the confirmation receipt with QR
Code
PhilHealth Customer Assistance,
Relations, and Empowerment Staff
2 ✔ print or take a digital image of the QR Code
through beneficiary’s camera or release the
confirmation slip (beneficiary’s copy of the
(P-CARES)
PhilHealth Konsulta Registration Form)
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ASSISTED REGISTRATION TO A FACILITY
1 Call 02-8441-7442
PhilHealth Corporate Action
Answer the Security
Center (CAC) 2 Questions
Get the Registration
3 Confirmation Details
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ASSISTED REGISTRATION TO A FACILITY
Accredited Konsulta Provider
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Registered to NHIP prior to KonSulTa
registration
All fields are mandatory.
Dependent’s PIN if beneficiary is DD.
Signatory should be the parent/guardian if
DD is below 21 y/o.
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Generation of KonSulTa
Registration Masterlist
HCI Certified
UPCM
Portal EMR
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GENERATION OF ATC
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HOW TO SECURE ATC?
THROUGH THROUGH THROUGH
LHIO OR PCARES LGU / OSCA (MPP) CORPORATE ACTION
CENTER (CAC)
Fill-out the Request for Fill-out the Request for
Authorization Transaction Code Authorization Transaction Code Call 02-8441-7442
(RATC) (RATC)
Submit to the authorized Submit to the authorized Staff Answer the Security Questions
PhilHealth Staff
Take a digital image of the QR Take a digital image of the QR Write the ATC
Code through beneficiary’s Code through beneficiary’s
camera or get a copy of ATC Slip camera or get a copy of ATC Slip
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ATC is only valid within
scheduled date of
assessment/consultation.
ATC will be needed for each
beneficiary (member or
dependent) for every health
assessment and consultation.
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eKonsulta HCI Portal
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NOTE: If ATC is not available, you may proceed to the Konsulta provider and provide consent to the facility to take your photo.
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SERVICE PROVISION
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PhilHealth KonSulTa Benefit
Consultation and case management for any conditions that can be
managed by a Primary Care Physician and team as determined by
the legal scope of practice.
Primary
Care
Provision of targeted individual health education Services
Assisting beneficiaries in accessing services in subcontracted or
partner facilities
Referral to specialty and higher levels of care
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-Copy and search PIN
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ePresS and eKAS- generated by facility and to be submitted to PhilHealth
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UPLOADING OF DATA RECORD
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Upload Konsulta
XML Report
HCI Certified
UPCM
Portal EMR
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SAP GENERATION & PAYMENT
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Generation of 1st
nd
and 2 tranche SAP
HCI
UPCM
Portal
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SAP GENERATOR
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• 1st Tranche
- Click SAP generator button (Portal)
* available within 1st-15th calendar day of the month
- SAP generation for tranche 1 shall be only once a month and is available from the 1st-15th day of
the succeeding month.
- Beginning 16th day until the end of the month, SAP generation shall be disabled.
• 2nd Tranche
- Click SAP generator button (Portal)
* available within 1st-15th calendar day of January of the immediate succeeding year
- SAP generation shall only be available from the 1st – 15th day of January of the immediate
succeeding year.
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SAP1 LEDGER
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-Email printed SAP to PhilHealth
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SAP MONITORING
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Capitation Tranches
Public(500.00) Private (750.00)
Based on Fair Fixed Costs
PHP 200.00 PHP 300.00
40% of the (max) (max) -Computed based on number
Capitation of members registered with
first patient encounter
+ + x number of remaining
months to deliver the service
(pro-rata computation)
PHP 300.00 PHP 450.00
60% of the (max) (max)
Based on Performance
Capitation
= =
-Computed based on
weighted indicators
PHP 500.00 PHP 750.00
/capita /capita
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FIRST PATIENT ENCOUNTER
- Initial episode of care whereby a primary
care worker takes and/or updates the
basic health data of an eligible beneficiary
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The first patient encounter can be ✓ Conduct of first patient
conducted by any primary care encounters (FPE) by nurses
worker including: and midwives in the barangay
Physicians Nurses Midwives health stations are allowed.
✓ FPE/consultations done by
the accredited Konsulta
provider in the clinics of
offices/employers are
permitted as well.
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✓ Conduct of first patient encounter (FPE) shall only apply to beneficiaries newly
registered to their Konsulta provider of choice.
✓ Beneficiaries who choose to remain or auto-registered with their current
Konsulta providers need not repeat their FPE during the succeeding years that
they remain registered with the same provider.
✓ However, should they transfer to another Konsulta provider, a new FPE shall
be required.
✓ For the purpose of computing the tranche 1, the initial FPE shall be counted
for the current and succeeding years that the beneficiary remains registered with
the Konsulta provider.
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Sample computation for the First Tranche for Public facility
Month Number Number of registered Calculation Sample
individuals with encountered data Capitation
registered per record per month
month
Jan 2,000 1,500 1,500 * 200.00 *(12/12) 300,000.00
Feb 2,000 2,000 2,000 * 200 .00* (11/12) 366,666.67
Mar 1,500 500 500 * 200.00 * (10/12) 83,333.33
Apr 3,500 3,000 3,000* 200.00 * (9/12) 450,000.00
May 2,000 600 600 * 200.00 * (8/12) 80,000.00
Jun 1,000 1,500 1,500 * 200.00 * (7/12) 175,000.00
Jul 500 1,000 1,000 * 200.00 * (6/12) 100,000.00
Aug 1,500 750 750 * 200.00 * (5/12) 62,500.00
Sep 2,500 1,300 1,300 * 200.00 * (4/12) 86,666.67
Oct 1,000 800 800 * 200.00 * (3/12) 40,000.00
Nov 1,500 1,000 1,000 * 200.00 * (2/12) 33,333.33
Dec 1,000 900 900 * 200.00 * (1/12) 15,000.00
Total
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PhilHealthOfficial
14,850 1,792,500.00
Sample computation for the Second Tranche for Public facility
Second Tranche = No. of registered beneficiaries with first patient encounter × Performance Factor ×
(Capitation Amount × 60%)
= 14,850 × 66% × (Php300.00)
= Php 2,272,050.00
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Note: HCI Performance Target HCI Weig Resulta
Catchment population refers to the number of registered beneficiaries Performanc ht nt
with encountered data record
= 14,850 beneficiaries
e Score
Count %
Performance Indicators a b = a/catchment c d = b/c e f = d *e
population
1 Primary Care Consultation: 14,850 100% 100% 100% .30 30%
Unique registered beneficiaries consulted a primary care provider
No. of unique individuals who consult at least one/Total
catchment population
2 Utilization of Laboratory Services: Unique laboratory services done 3,000 20% 50% 40% .30 12%
No. of unique laboratory service done/Total catchment
population
3 Dispensing of Medicines: Unique registered beneficiaries who received 2,000 13% 15% 90% .10 9%
antibiotics as prescribed by their primary care doctor
No. of unique individuals who received medicines for
communicable diseases/Total catchment population
4 Dispensing of Medicines: Unique registered beneficiaries who received 1,500 10% 20% 51% .30 15%
NCD medication as prescribed by their primary care doctor (20%)
Total of unique individuals who received non-communicable
medicines/Total catchment population
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66%
Thank you!
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