BluHealth

𝐏𝐑𝐎 𝐍𝐂𝐑 𝐀𝐝𝐯𝐢𝐬𝐨𝐫𝐲 𝐧𝐨. 𝟐𝟎𝟐𝟔-𝟎𝟑-𝟎𝟏𝟖: 𝐌𝐀𝐍𝐃𝐀𝐓𝐎𝐑𝐘 𝐌𝐀𝐈𝐍𝐓𝐄𝐍𝐀𝐍𝐂𝐄 𝐎𝐅 𝐋𝐀𝐁𝐎𝐑𝐀𝐓𝐎𝐑𝐘 𝐑𝐄𝐒𝐔𝐋𝐓𝐒 𝐀𝐍𝐃 𝐏𝐑𝐎𝐎𝐅 𝐎𝐅 𝐃𝐈𝐒𝐏𝐄𝐍𝐒𝐈𝐍𝐆 𝐅𝐎𝐑 𝐀𝐍𝐘 𝐎𝐅 𝐓𝐇𝐄 𝟐𝟏 𝐌𝐄𝐃𝐈𝐂𝐀𝐓𝐈𝐎𝐍𝐒 𝐔𝐍𝐃𝐄𝐑 𝐓𝐇𝐄 𝐘𝐀𝐊𝐀𝐏 𝐂𝐋𝐈𝐍𝐈𝐂 𝐒𝐄𝐑𝐕𝐈𝐂𝐄𝐒 𝐅𝐎𝐑 𝐂𝐘 𝟐𝟎𝟐𝟓 𝐎𝐍𝐖𝐀𝐑𝐃𝐒

To ensure the integrity of the National Health Insurance Program, all accredited YAKAP Clinics are hereby reminded of their responsibility to maintain complete and verifiable medical documentation for all outpatient consultations and services.

Effective immediately, all providers must ensure that the following documents are readily available in the patient’s medical records (Electronic Medical Record and/or Physical Chart), if applicable, for audit, monitoring, and payment validation purposes, specifically covering all medical records from Calendar Year (CY) 2025 onwards:

1.Electronic Konsulta Availment Slip (eKAS) optional (printed or soft copy)
2. Electronic Prescription Slip (ePresS) optional (printed or soft copy)
3. Copies of results for all diagnostic tests conducted as part of the benefit package.
4. Valid documentation confirming beneficiary’s receipt of any of the 21 essential medications covered under the YAKAP Clinic services.

The presence of laboratory results and proof of dispensing for encounters requiring services starting January 1, 2025, shall be manual or electronic verified during monitoring visits and post-payment audits. Failure to produce these documents during an assessment shall be recorded as findings under the Quality of Care domains of the Health Care Provider Performance Assessment System (HCP PAS).

Strict compliance is enjoined to ensure the continuous and efficient delivery of primary care services to our members