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Outsourcing Alert

Clarifications on the coverage of the PhilHealth Outpatient Emergency Care Benefit (OECB Package) and recording of Core Presentation

The Outpatient Emergency Care Benefit (OECB Package) covers emergent and urgent cases seen in the Emergency Department, regardless of the condition or chief complaint of the patient.

The Annex B of PhilHealth Circular (PC) No. 2024-0033 lists the Core Presentations which are categorisations of the patient’s chief complaint to be used for documentation and data collection purposes.

Annex B also states the following: “The list of core presentations covered by the benefit package which are categorised as potentially emergent to critical by triage level. These classifications are only recommendations and are subject to change upon assessment of the attending physician at point of care.”

The Core Presentation does not replace the declared chief complaint but reflects the closest equivalent to it. PC No. 2024-0033 Section VII.B.2. Transitory Clause, prescribes the format of the input in the Chief Complaint field of Claim Form 4, which states:

“All filed claims shall include in the Chief Complaint field of Claim Form 4 the corresponding Core Presentation included in Annex B aside from the declared chief complaint of the patient for standardisation of claims. (Example: Cough [Difficulty of Breathing], Chest heaviness [Chest pain])...” 

Further inquiries may be referred to PhilHealth Action Center at (02) 8662-2588 or email at actioncenter@philhealth.gov.ph or any PhilHealth Regional Offices and Local Health Insurance Offices.

For the information and guidance of all concerned.

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