primary care benefit 1 - Philippine Health Insurance Corporation

Box II.
PCB Participation No. – The number assigned by PhilHealth to the PCB provider which is
reflected in its Certificate of Eligibility to Participate (CEP)
Box III.
Municipality/City /Province – location of the health facility
Box IV.
Obligated Services
1. Target Column – place the total number of NHIP members and dependents set by
PHIC as the facility’s target for each particular obligated service for that quarter. The
targets must be consistent with the submitted Provider’s Agreement Form for
Obligated Services (Annex E).
2. Accomplishment Column – place the total number of NHIP members and dependents
that were provided the service for each partcular obligated service for that quarter.
Box V.
Members and Dependents Served
1. In reference to Annex A.2, Box II, reflect the data on the appropriate fields based on
gender distribution.
2. Reflect also the total based on Annex A2, Box II.
3. Make sure that the horizontal (Total based on gender) and the vertical (based on age
distribution) sums are correct. Write this value on the right lower space of Box V.
Box VI.
Benefits/Services Provided
1. Data for this report shall be the sum of each service provided as reflected in Annex
A.5 based on gender distribution.
2. Data for referred benefits/services shall come from consolidated data of Annex A.3,
Part I. Referred Column
Box VII.
Medicines Given
1. Based on all accomplished Annex A.5, determine the different medications given to
NHIP members or dependents based on gender distribution.
2. The medications should be written in its generic form.
Box VIII.
Top 10 Common Illnesses (Morbidity)
1. Enumerate the top 10 diagnosis of common causes of consult of patients in the
facility.
2. Tabulate these according to the number of cases seen within the applicable quarter,
from highest incidence to lowest.
24