Compliance

The obligations a primary care facility carries — and where the system carries them with you

A rural health unit answers to PhilHealth for what it claims, to the Department of Health for what it reports, and to the National Privacy Commission for what it holds. eMRCare removes none of those duties. It puts each one on a screen, with a clock and a named person against it, so nothing depends on somebody remembering.

categories of check a claim must clear before it can be transmitted

24 hours

the RA 11332 clock on an immediately notifiable case, counted from detection

72 hours

the NPC notification window on a personal data breach, counted from discovery

PhilHealth eClaims

A bad claim should fail in the clinic, not weeks later at PhilHealth

Everything sent to PhilHealth costs the facility something. A transmittal is consumed whether or not the claim proves payable, and a rejected claim comes back weeks later — often after the filing window has closed, by which point the money is gone.

So a claim is checked against PhilHealth's own published rules before it may leave. The clerk sees the problem while the record is still open, in the words a clerk uses, with the page to go and fix it.

Checked	What it catches
Configuration	The facility's own accreditation details and transmission credentials.
Member	Membership and eligibility details PhilHealth tests on receipt.
Patient	Identifiers and demographics the form requires and the record lacks.
Claim	The claim's own fields — dates, case rate, diagnosis and procedure coding.
Documents	Claim Form 1, Claim Form 2 and the electronic Statement of Account, present and fetchable.
Timing	Dates outside the window PhilHealth will accept.

Two failures are kept apart. Blockers stop transmission outright. Warnings do not — they are things PhilHealth tolerates but which reduce what is paid, such as a missing physician accreditation number, which costs the professional fee. Both are shown; only one stops the send.

Documents and follow-through

Attached securely, then tracked until it is settled

Supporting documents

The required forms are generated from the record, encrypted so only PhilHealth can open them, and published where PhilHealth can fetch them. Preparing documents is a separate step from transmitting, so a failed upload is a problem you retry — not a transmittal already spent.

Claim status

Submitted claims are polled and their status updated from PhilHealth's own answer, so the list reflects where each one actually stands. Nothing is marked paid on assumption.

Series reconciliation

Transmittal and claim series numbers are issued by the system, never reused, and reconciled against what was sent. A duplicated number is a duplicate submission.

Konsulta reporting

What is built, and what live PhilHealth still needs

Konsulta reporting is a different submission from eClaims on a different channel, tied to capitation rather than claims. The coded-value catalogue holds every code library the report cites, each importable and versioned, and states at any moment which are still empty. Reference numbering is complete: the five report series — transmittal, patient case, enlistment, profile and encounter record — are issued to the exact composition PhilHealth specifies, counted per facility and month, and never reissued. The report path itself — build, check, send and receipt — runs end to end against a local PhilHealth stand-in in demo.

The builder refuses to consider itself ready while any library is empty or holds a locally invented value. A report assembled from guessed codes is worse than no report.

Where the Konsulta report itself stands. In demo, reports can be built, checked, sent and receipted without live credentials — the screens talk to a local PhilHealth stand-in. Production transmission still depends on what only PhilHealth issues to accredited providers: the contents of the twenty-seven code libraries the report draws on, the report's published structure — the field order and nesting a valid submission must follow — and the facility's own credentials and configuration. A data dictionary gives field names, types and widths; it does not give that grammar, and inferring it would produce submissions that fail validation at PhilHealth's end. When a facility loads its libraries, structure and credentials under its own accreditation, the same path talks to the live service.

Capitation itself does not depend on this: payment follows empanelment and the First Patient Encounter, which the capitation register already tracks.

RA 11332

Notifiable diseases, and the clock that starts at detection

The Mandatory Reporting of Notifiable Diseases and Health Events of Public Health Concern Act puts a legal duty on the facility, and for immediately notifiable conditions that duty runs in hours, not weeks. Case reports are raised from the encounter that found them, so the clinical detail is already there. Each disease carries its own reporting frequency, and the register counts the hours since detection against it.

The 24-hour count

An immediately notifiable case still open more than 24 hours after detection is shown as overdue — not buried in a list, but stated as a number the officer sees on opening the page.

Weekly returns

Weekly-frequency conditions are collected and exported for the surveillance return, alongside the Department of Health field health service information system reports already filed.

Data Privacy Act — RA 10173

A health record is sensitive personal information, and is treated as such

Consent, and its withdrawal

Informed consent is captured against the patient record, printable, and revocable — consent that cannot be withdrawn is not consent. The record shows what was agreed, when, and by whom.

Role-based access

Each staff role has its own dashboard, showing only that role's work — a physician, a midwife, a pharmacist and a records encoder do not open the same screen. A user never reaches a page their role does not permit, and a guessed address returns a refusal rather than a record.

Per-facility isolation

Several facilities can share one deployment and none can see another's patients — a municipality runs its health centres together without pooling the records into one undivided pile.

Complete audit trail

Every access and change is written to an audit log with the user, the record and the time. Overrides of serious clinical warnings keep the reason the prescriber gave. "Who opened this chart" has an answer.

Breach register, and the 72-hour clock

Incidents are registered under RA 10173 and NPC Circular 16-03 with category, severity, detection time, data subjects affected and resolution — restricted to the highest administrative role. Each open incident carries the hours elapsed against the NPC notification window, and anything past 72 hours with no notification recorded is counted as overdue at the top of the register.

What the system does not do for you

eMRCare supports a facility in meeting its obligations. It does not confer them. PhilHealth and Konsulta accreditation, Department of Health licensing, and registration of the facility's data processing systems with the National Privacy Commission all remain the facility's own to obtain and maintain. We would rather say so on the page than in a meeting later.

Also worth reading: how capitation is earned, the clinical modules, and the hospital link.

Request a walkthrough