Philhealth accreditation for nurses as professional healthcare providers

Good news to all registered nurses! Philippine Health Insurance Corporation (PhilHealth) announces that they are now accepting nurses application for accreditation as professional healthcare providers for maternal and child health services and receive payment for rendered services.

PhilHealth issued Circular 2017-0023 published last December 29, 2017, recognizing the nurses’ role in the healthcare delivery system thus opening the accreditation as providers of maternity care, newborn care and normal spontaneous delivery packages in accredited birthing homes.

They may also be accredited and receive payments for family planning services such as IUD insertion and Subdermal Contraceptive Implant, subject to additional requirements.

STANDARDS FOR ACCREDITATION OF NURSES
A. The nurse must be a licensed practitioner.
B. The RNs must adhere to the standards of nursing practice and Code of Ethics for RNs.
C. They must comply with the provisions set forth in the Performance Commitment for professionals and any other requirements that may be determined by the Corporation.
D. They must be members of the National Health Insurance Program with qualifying premium contributions. E. The nurse must have completed training on Basic Emergency Obstetric and Newborn Care from DOH institutions.
F. The nurse must have work experience for at least 2 years in the labor and delivery room of at least a level one hospital.

REQUIREMENTS FOR ACCREDITATION
A. Initial and Renewal
1. Updated PRC license or its equivalent;
2. Completely filled out Provider Data Record (PDR) (Annex A below)
3. Filled out and signed performance commitment (PC) for health care professionals.
4. 2 pieces of 1″ x 1″ photo with the applicant’s name at the back
5. Proof of payment of Premium contributions

B. Additional Requirements for Initial Accreditation
1. Certificate of training on the Basic Emergency Obstetric- and Newborn Care (BEmONC) for nurses from a DOH-recognized training center for BEmONC skills
2. Certification of work experience for at least two (2) years in the labor and delivery room of at least a level one (1) hospital

C. Additional Requirements For Professional Providers Who will Provide Family Planning Services Professional Health Care Providers who are awaited for PhilHealth’s Maternity Care Package/NSD Package in accredited birthing homes/ maternity and Lying-in clinics are also qualified to provide health services for some family planning related procedures that are covered by PhilHealth. They are required to have competency/ies to perform such procedures and shall be required to submit the following certificates of training from DOH recognized trainers prior to claims reimbursement:
1. IUD insertion as first case rate only
Certificate: Family Planning Competency Based Training (FPCBT) Level 2, or Comprehensive Family Planning Course

2. IUD insertion as first case rate; and IUD insertion as second case rate (e.g. post-partum IUD insertion)
Certificate: Post-partum IUD Training Course

3. Subdermal Contraceptive Implant Package
Certificate of Training on Subdermal Implant Insertion and Removal

You may view or download the full text on Philhealth Guidelines here: http://bit.ly/nursesphilhealth

FREQUENTLY ASKED QUESTIONS
1. Will the policy apply to both government and private professional providers?
Yes, the policy applies to both government and private nurses.

2. Can the nurse employed in a government Health Care Institution (HCI) apply for
accreditation and be a provider in an accredited birthing home?
Nurses employed in government HCIs can apply for accreditation and be professional
providers in an accredited birthing home so long as they are allowed by the head of the
agency to practice after official working hours.

3. Are the nurses required to be members of the Philippine Nurses Association?
Membership in the PNA is not a requirement for accreditation, but nurses are encouraged to
do so.

4. Does a nurse need a partner physician, like the midwives, to be accredited?
As stated in PhilHealth circular 30 s. 2009, the professional provider shall have a partner
physician for OB cases and a partner for pediatric cases.

5. How much will the RN receive for the services being rendered?
The professional providers shall receive 40% of the package rates for the NSD/ MCP(Php
8,000), SubdermalContraceptive Implant (Php 3,000)and IUD insertion (Php 2,000)
packages.

“The nurses play a vital role in the health care delivery system in the country,” Philhealth said.

“They comprise a number of health care professionals and are one of the promoters of primary health care, acting as front liners in communities to deliver public health care services.”

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