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    Transmittal Philhealth

    Uploaded by

    Annette Aquino Guevarra
    This document contains claims from SMMC Paanakan Hospital for PhilHealth reimbursement. It includes information such as patient and member names, confinement periods, diagnoses and claim amounts for a total of 38 claims. The claims are for delivery cases and the diagnoses provided are related to pregnancy and delivery. The document provides details of reimbursement claims being filed by the hospital to PhilHealth.

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    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd

    Transmittal Philhealth

    Uploaded by

    Annette Aquino Guevarra
    198 views7 pages
    This document contains claims from SMMC Paanakan Hospital for PhilHealth reimbursement. It includes information such as patient and member names, confinement periods, diagnoses and claim amounts for a total of 38 claims. The claims are for delivery cases and the diagnoses provided are related to pregnancy and delivery. The document provides details of reimbursement claims being filed by the hospital to PhilHealth.

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    transmittal for philhealth

    Original Title

    TRANSMITTAL PHILHEALTH

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    This document contains claims from SMMC Paanakan Hospital for PhilHealth reimbursement. It includes information such as patient and member names, confinement periods, diagnoses and claim amounts for a total of 38 claims. The claims are for delivery cases and the diagnoses provided are related to pregnancy and delivery. The document provides details of reimbursement claims being filed by the hospital to PhilHealth.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    198 views7 pages

    Transmittal Philhealth

    Uploaded by

    Annette Aquino Guevarra
    This document contains claims from SMMC Paanakan Hospital for PhilHealth reimbursement. It includes information such as patient and member names, confinement periods, diagnoses and claim amounts for a total of 38 claims. The claims are for delivery cases and the diagnoses provided are related to pregnancy and delivery. The document provides details of reimbursement claims being filed by the hospital to PhilHealth.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    of 7

    Republic of the Philippines

    Philippines Health Insurance Corporation


    Lucena Grand Terminal, Lucena City
    Category: PRIVATE-EMPLOYED
    NEWFILE/REFILE
    Hospital/ Health Provider: SMMC Paanakan
    Address: #47 P. ALCANTARA ST. BRGY. VII-B, SAN PABLO CITY, LAGUNA
    Accreditation No.: M41017565
    PHILHEALTH
    NUMBER

    NAME OF
    MEMBER

    NAME OF
    PATIENT

    CONFINEMENT
    PERIOD

    08-0255476991

    Romel S.
    Castillo

    Cael Andrey M.
    Castillo

    05-15-2016 TO
    05-17-2016

    Total No. of Claims: 1 CLAIM


    Prepared By:
    APRIL D . NOOL, RN
    Name & Signature of Hospital Representative

    Transmittal No:
    Philhealth
    FINAL
    DIAGNOSIS
    G3P3(3-0-0-3) PU
    39
    4/7 WEEKS AOG
    VIA LMP,
    CEPHALIC IN
    LABOR

    CLAIM
    AMOUNT

    P 1,550.00

    Republic of the Philippines


    Philippines Health Insurance Corporation
    Lucena Grand Terminal, Lucena City
    Category: PRIVATE-EMPLOYED
    NEWFILE/REFILE
    Hospital/ Health Provider: SMMC Paanakan
    Address: #47 P. ALCANTARA ST. BRGY. VII-B, SAN PABLO CITY, LAGUNA
    Accreditation No.: M41017565
    PHILHEALTH
    NUMBER

    NAME OF
    MEMBER

    NAME OF
    PATIENT

    CONFINEMENT
    PERIOD

    0-80254224905

    ARLENE
    CUASAY
    VILLANUEVA

    ARLENE
    CUASAY
    VILLANUEVA

    04-17-2015 TO
    04-18-2015

    0-80254224905

    ARLENE
    CUASAY
    VILLANUEVA

    ASHLEY RAVEN
    CUASAY
    VILLANUEVA

    04-17-2015 TO
    04-18-2015

    0-80512518153

    ISABEL CAIG
    BUENCILLO

    ISABEL CAIG
    BUENCILLO

    03-19-2015 TO
    03-20-2015

    0-80512518153

    ISABEL CAIG
    BUENCILLO

    QUEEN ALLYSA
    CAIG
    BUENCILLO

    03-19-2015 TO
    03-20-2015

    Total No. of Claims: 4 CLAIMS


    Prepared By:

    Transmittal No:
    Philhealth
    FINAL
    DIAGNOSIS
    G4P4(4-0-0-4) PU
    40 WEEKS AOG
    VIA LMP,
    CEPHALIC IN
    LABOR
    FULL TERM BABY
    GIRL DELIVERED
    VIA NSD
    G3P3(3-0-0-3) PU
    40 WEEKS AOG
    VIA LMP,
    CEPHALIC IN
    LABOR
    FULL TERM BABY
    GIRL DELIVERED
    VIA NSD

    CLAIM
    AMOUNT

    P 8, 000.00

    P 1, 550.00

    P 8, 000.00

    P 1, 550.00

    HERLENE LANI S. NOOL, RN


    Name & Signature of Hospital Representative
    Republic of the Philippines
    Philippines Health Insurance Corporation
    Lucena Grand Terminal, Lucena City
    Category: PRIVATE-EMPLOYED
    NEWFILE/REFILE
    Hospital/ Health Provider: SMMC Paanakan
    Address: #47 P. ALCANTARA ST. BRGY. VII-B, SAN PABLO CITY, LAGUNA
    Accreditation No.: M41017565
    PHILHEALTH
    NUMBER

    NAME OF
    MEMBER

    NAME OF
    PATIENT

    CONFINEME
    NT
    PERIOD

    0-80511342655

    RENATO
    CUBILLA
    BENUSA

    MICHELLE
    CUATON
    BENUSA

    03-06-2015
    TO
    03-07-2015

    0-80511342655

    RENATO
    CUBILLA
    BENUSA

    RHEA MAE
    CUATON
    BENUSA

    03-06-2015
    TO
    03-07-2015

    0-80507189273

    MARK ANTHONY
    LAURESTA
    NATAL

    RAQUEL
    CERVANA
    NATAL

    03-22-2015
    TO
    03-23-2015

    0-80507189273

    MARK ANTHONY
    LAURESTA
    NATAL

    MARIEL
    CERVANA
    NATAL

    03-22-2015
    TO
    03-23-2015

    0-80253922773

    JULIE
    VILLALOBOS
    BALANI

    JULIE
    VILLALOBOS
    BALANI

    03-08-2015
    TO
    03-09-2015

    0-8025392277-

    JULIE

    PRINCE YUAN

    03-08-2015

    Transmittal No:

    FINAL DIAGNOSIS
    G2P2(2-0-0-2) PU 40
    WEEKS AOG VIA
    LMP, CEPHALIC IN
    LABOR
    FULL TERM BABY
    GIRL DELIVERED VIA
    NSD
    G4P4(4-0-0-4) PU 41
    WEEKS AOG VIA
    LMP, CEPHALIC IN
    LABOR
    FULL TERM BABY
    GIRL DELIVERED VIA
    NSD
    G3P3(3-0-0-3) PU 38
    WEEKS AOG VIA
    LMP, CEPHALIC IN
    LABOR
    FULL TERM BABY

    Philhealth

    CLAIM
    AMOUNT

    P 8, 000.00

    P 1, 550.00

    P 8, 000.00

    P 1, 550.00

    P 8, 000.00
    P 1, 550.00

    VILLALOBOS
    BALANI

    BALANI
    SORIANO

    TO
    03-09-2015

    BOY DELIVERED VIA


    NSD

    Total No. of Claims: 6 CLAIMS


    Prepared By:
    HERLENE LANI S. NOOL, RN
    Name & Signature of Hospital Representative
    Republic of the Philippines
    Philippines Health Insurance Corporation
    Lucena Grand Terminal, Lucena City
    Category: PRIVATE-EMPLOYED
    NEWFILE/REFILE
    Hospital/ Health Provider: SMMC Paanakan
    Address: #47 P. ALCANTARA ST. BRGY. VII-B, SAN PABLO CITY, LAGUNA
    Accreditation No.: M41017565
    PHILHEALTH
    NUMBER

    NAME OF
    MEMBER

    NAME OF
    PATIENT

    CONFINEMENT
    PERIOD

    0-80255263580

    ROSE-ANN
    PARDO TARIM

    ROSE-ANN
    PARDO TARIM

    05-06-2015 TO
    05-08-2015

    0-80255263580

    ROSE-ANN
    PARDO TARIM

    AFYIAH TARIM

    05-06-2015 TO
    05-08-2015

    0-80257848330

    CHERRY MAY
    LOPEZ
    SERRANO

    CHERRY MAY
    LOPEZ
    SERRANO

    04-03-2015 TO
    04-04-2015

    Transmittal No:
    Philhealth
    FINAL
    DIAGNOSIS
    G3P3(3-0-0-3) PU
    39 2/7 WEEKS
    AOG VIA LMP,
    CEPHALIC IN
    LABOR
    FULL TERM BABY
    GIRL DELIVERED
    VIA NSD
    G2P2(2-0-0-2) PU
    40 5/7 WEEKS
    AOG VIA LMP,
    CEPHALIC IN
    LABOR

    CLAIM
    AMOUNT

    P 8, 000.00

    P 1, 550.00

    P 8, 000.00

    0-80257848330

    CHERRY MAY
    LOPEZ
    SERRANO

    KAIZER LOPEZ
    SERRANO

    04-03-2015 TO
    04-04-2015

    FULL TERM BABY


    BOY DELIVERED
    VIA NSD

    P 1, 550.00

    Total No. of Claims: 4 CLAIMS


    Prepared By:
    HERLENE LANI S. NOOL, RN
    Name & Signature of Hospital Representative
    Republic of the Philippines
    Philippines Health Insurance Corporation
    Lucena Grand Terminal, Lucena City
    Category: PRIVATE-EMPLOYED
    NEWFILE/REFILE
    Hospital/ Health Provider: SMMC Paanakan
    Address: #47 P. ALCANTARA ST. BRGY. VII-B, SAN PABLO CITY, LAGUNA
    Accreditation No.: M41017565
    PHILHEALTH
    NUMBER

    NAME OF
    MEMBER

    NAME OF
    PATIENT

    CONFINEMENT
    PERIOD

    0-20503062667

    LIEZL ALEMAN
    AMOGUIS

    LIEZL ALEMAN
    AMOGUIS

    03-15-2015 TO
    03-17-2015

    0-20503062667

    LIEZL ALEMAN
    AMOGUIS

    0-0043233475-

    REYNALDO

    TIFFANY BLAIR
    AMOGUIS
    BALYOYO
    ANA JANE

    03-15-2015 TO
    03-17-2015
    03-11-2015 TO

    Transmittal No:
    Philhealth
    FINAL
    DIAGNOSIS
    G3P3(3-0-0-3) PU
    39 6/7 WEEKS
    AOG VIA LMP,
    CEPHALIC IN
    LABOR
    FULL TERM BABY
    GIRL DELIVERED
    VIA NSD
    G5P5(5-0-0-5) PU

    CLAIM
    AMOUNT

    P 8, 000.00

    P 1, 550.00
    P 8, 000.00

    BRAZA
    CORNISTA JR.

    MERCADO
    COTONER

    03-13-2015

    0-00432334755

    REYNALDO
    BRAZA
    CORNISTA JR.

    JIREH COTONER
    CORNISTA

    03-11-2015 TO
    03-13-2015

    38 WEEKS AOG
    VIA LMP,
    CEPHALIC IN
    LABOR
    FULL TERM BABY
    BOY DELIVERED
    VIA NSD

    P 1, 550.00

    Total No. of Claims: 4 CLAIMS


    Prepared By:
    HERLENE LANI S. NOOL, RN
    Name & Signature of Hospital Representative
    Republic of the Philippines
    Philippines Health Insurance Corporation
    Lucena Grand Terminal, Lucena City
    Category: PRIVATE-EMPLOYED
    NEWFILE/REFILE
    Hospital/ Health Provider: SMMC Paanakan
    Address: #47 P. ALCANTARA ST. BRGY. VII-B, SAN PABLO CITY, LAGUNA
    Accreditation No.: M41017565
    PHILHEALTH
    NUMBER

    NAME OF
    MEMBER

    NAME OF
    PATIENT

    CONFINEMENT
    PERIOD

    0-80506945376

    MARLON
    MARAO
    CADAHING

    SHA-SHA
    ABENIDO
    CADAHING

    04-11-2015 TO
    04-12-2015

    Transmittal No:
    Philhealth
    FINAL
    DIAGNOSIS
    G1P1(1-0-0-1) PU
    37 5/7 WEEKS
    AOG VIA LMP,
    CEPHALIC IN
    LABOR

    CLAIM
    AMOUNT

    P 8, 000.00

    0-80506945376

    MARLON
    MARAO
    CADAHING

    PRINCESS ELLIE
    ABENIDO
    CADAHING

    04-11-2015 TO
    04-12-2015

    0-90500896743

    WILFREDO
    MARTINEZ
    VILLANUEVA

    JADICE QUEEN
    SUSMERANO
    VILLANUEVA

    03-20-2015 TO
    03-22-2015

    0-90500896743

    WILFREDO
    MARTINEZ
    VILLANUEVA

    SOFIA ANICAH
    SUSMERANO
    VILLANUEVA

    03-20-2015 TO
    03-22-2015

    O;Total No. of Claims: 4 \LAIMSI,


    Prepared By:
    HERLENE LANI S. NOOL, RN
    Name & Signature of Hospital Representative

    FULL TERM BABY


    GIRL DELIVERED
    VIA NSD
    G2P2(2-0-0-2) PU
    39 4/7 WEEKS
    AOG VIA LMP,
    CEPHALIC IN
    LABOR
    FULL TERM BABY
    GIRL DELIVERED
    VIA NSD

    P 1, 550.00

    P 8, 000.00

    P 1, 550.00

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