PhilHealth Guidelines for Filing of Applications for Accreditation of Hospitals

The following are the Philippine Health Insurance Corporation (PhilHealth) guidelines for the filing of Applications for Accreditation of Hospitals: Hospitals applying for accreditation shall conduct a self-assessment of their compliance to the Benchbook Standards of Accreditation for hospitals prior to submission of their application for accreditation. The Benchbook Self-assessment and Survey Tool shall be available at PhilHealth Regional/Service Office. It may also be downloaded from the Philhealth website at www.philhealth.gov.ph. Prior to applying for accreditation, hospitals should address their areas for improvement to qualify for the accreditation award they are applying for. They shall determine the accreditation award they will apply for based on their actual self-assessment scores.

The mode of pre-accreditation survey shall be based on the actual scores reflected in the Benchbook Self-assessment Summary, as follows:

Award Applied for	Self Assessment Result	Mode of Pre-accreditation
Center of Excellence	Center of Excellence	Center of Excellence
	Center of Quality	Center of Quality
	Center of Safety	Center of Safety
	Failed	Center of Safety
Center of Quality	Center of Quality or higher	Center of Quality
	Center of Safety	Center of Safety
	Failed	Center of Safety
Center of Safety	Center of Safety or higher	Center of Safety
	Failed	Center of Safety

Example 1: A hospital applied for Center of Quality but failed the self-assessment; i.e., it did not meet the minimum scores required for Center of Safety. The PhRO will survey the hospital as if it applied only for Center of Safety - only the 51 core indicators and the three basic safety performance areas (patient rights and organizational ethics, patient care, and safe practice and environment) will be assessed during the pre-accreditation survery.  Thus, the length and extent of the pre-accreditation survey will be reduced, saving time and resources both for the hospital and PhilHealth. In this example, the highest award that that the hospital can receive is Center of Safety. If it wants to upgrade to a higher award, the hospital should apply for re-accreditation for upgrading of award after receipt of the decision on its application and prepare for a re-survey for the higher award.

Hospitals that failed the self-assessment may still apply for accreditation. However, they should already address their areas for improvement, especially the core indicators, before the actual date of pre-accreditation survey.

Hospitals shall submit the following requirements when applying for accreditation:

1. PhilHealth application form for accreditation - properly accomplished
2. Warranties of accreditation - duly notarized
3. Proof of payment of accreditation fee
4. DOH License -with validity applicable to the accreditation period
5. Certificate of Membership in PHA/PHAP - with validity applicable to the accreditation period
6. Benchbook Score Sheet (part 2 of the Benchbook Self-assessment forms- Manual 2)
7. Benchbook Self-Assessment Summary (part 3 of the Benchbook Self-assessment forms- Manual 2)
8. Statements of Intent (SOI) - if applicable (PC no. 32 s. 2010 as Annex A)
1. For initial Accreditation/Re-Accreditation
2. For Downgrading of Accreditation Award

The accomplished Self-Assessment and Survey Tool (part 1 of the Benchbook Self-assessment forms - Manual 2) shall be retained in the hospital and included in the document review during the actual pre-accreditation survey by PhilHealth

For renewal of accreditation, hospitals shall file their applications during the incentive period, December 1 - 31 of the current year or until the prescribed filing period, January 1- 31 of the succeeding year. (For the May 1, 2011 to April 30, 2012 accreditation period, the regular filing period for renewal shall be on January 1 to 31, 2011.)

Hospitals that are awarded as Centers of Quality or Excellence (currently or in the future) shall submit their updated DOH-OSS licenses and pay the application fees from January 1-31 of the succeeding year(s). Claims of said hospitals for patients with admission dates starting January 1 shall only be processed upon submission their updated DOH license to operate and payment of accreditation fee.

For hospitals that were granted provisional accreditation upon the effectivity of this issuance, applications for renewal of accreditation shall be filed on January 1-31, 2011.

Applications for initial accreditation or re-accreditation may be filed anytime.

The accreditation of hospitals whose applications for renewal of accreditation for accreditation period May 1, 2010 to April 30, 2011 were denied shall be valid only from May 1, 2010 up to 30 calendar days from the receipt of the notice of denial of accreditation or until the end of the current accreditation period on April 30, 2011, whichever comes first. These hospitals have two options, namely:

1. Option 1. Apply for re-accreditation for the remaining days of the current accreditation period ending April 30, 2011. If the application is approved, the hospital shall again apply for renewal of accreditation within 30 days from receipt of the notice of approval of accreditation.
2. Option 2. Apply for re-accreditation for the accreditation period May 1, 2011 to April 30, 2012 with the start date of accreditation effective May 1, 2011 if approved. The hospital may incur a gap from the end of the previous accreditation up to April 30, 2011.

The provisions of PhilHealth Circular Nos. 50 s. 2006 and 15 s. 2010 that are consistent with this circular shall remain in effect. All other existing issuances inconsistent with this circular are hereby repealed and/or amended accordingly.

You can download the following attachments by clicking the following links below:

• Download Checklist of Requirements for Application for Accreditation of Institutional Health Care Provider (Annex 1)
• Download Pre-Accreditation (Preliminary) Survey Report (Annex 2).
  

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