FINANCIAL ASSISTANCE

PROCESSING OF REQUESTS FOR INDIVIDUAL MEDICAL ASSISTANCE PROGRAM (IMAP)

Office/Department in Charge: Fund Allocation Department
Location: PCSO-Lung Center of the Philippines Office
Schedule of availability of service: Mondays to Fridays 6:00 AM - 5:00PM
Who May Avail of the Service: (per Board Resolution 272)
All disadvantaged individuals with health and physical problem shall avail of the Individual Medical Assistance Program (IMAP) provided that she/he meets the
following criteria:
1. Poverty Threshold of P19,345.00 (urban) and P16,508.00 (rural) per person per year for food and non-food items (as per National Statistics Coordination Board)
2. Patients confined in the Charity Ward
3. Patients who are confined in the Pay Ward by reasons beyond their control such as:
- Emergency cases
- Non-availabilty of Charity Ward
- Communicable diseases which need isolation
- Intensive Care Unit cases
- Maternity with complications
4. Out patients who are in need of chemo, post operative medication, OR needs, antibiotics, laboratory and diagnostics procedures or those patients whose illness
does not need confinement.
What are the initial requirements:
REQUEST FOR HOSPITALIZATION
1. Personal Letter Request addressed to Chairman/General Manager of PCSO
2. Original/Certified True Copy of the Updated Clinical Abstract signed by the doctor with license & PTR #
3. Statement of account/hospital bill certified by the billing officer/credit supervisor with printed name and signature
4. Endorsement letter from the hospital social service patients; or from the Credit and Collection Officer for pay patients
5. Social Case Study Report from Local Government Unit (optional)
6. Promissory Note (if discharged)
7. Valid ID (patient and representative)
REQUEST FOR MEDICINES AND CHEMO
1. Personal Letter Rquest addressed to Chairman/General Manager of PCSO
2. Original/Certified True Copy of the Updated Clinical Abstract signed by the doctor with license & PTR #
3. Prescription with printed name, signature and license # of the attending physician
4. Official Price Quotation from the pharmacy (c/o PCSO)
5. Social Case Study Report from Local Government Unit (optional)
6. Original/Certified True Copy of histopath/biography report duly signed by pathologist with printed name and license/PTR #
7. Relevant laboratory test results (e.g. Pathology Report)
8.Valid ID (patient and representative)
REQUEST FOR LABORATORY/DIAGNOSTICS PROCEDURES
1. Personal Letter Request addressed to Chairman/General Manager of PCSO
2. Original/Certified True Copy of the Updated Clinical Abstract signed by the doctor with the license & PTR #
3. Order form from the doctor duly signed with license number stating need for procedure
4. Official Costing of the said procedure from the laboratory section department of the hospital

5. Social Case Study Report from Local Government Unit (optional)

6. Valid ID (patient and representative)
REQUEST FOR IMPLANT/PROSTHESIS/WHEELCHAIR
1. Personal Letter Request addressed to Chairman/General Manager of PCSO
2. Original/Certified True Copy of the Updated Clinical Abstract signed by the doctor with license & PTR #
3. Three (3) Official Price Quotation from different suppliers
4. One (1) whole body picture for the wheelchair request
5. Social Case Study Report from the Local Government Unit (optional)
6. Prescription/Specifications of the implant needed
7. Proof of counterpart from the patient/client
8. Photocopy of x-ray report for implants
9. Valid ID (patient and representative)
REQUEST FOR DIALYSIS
1. Personal Letter Request addressed to Chairman/General Manager of PCSO
2. Original/Certified True Copy of the Updated Clinical Abstract signed by the doctor with license & PTR #
3. Endorsement/Certificate of Acceptance of PCSO guarantee letter from the hospital or dialysis center
4. Official Price Quotation of dialysis
5. Social Case Study Report from Local Government Unit (optional)
6. Relevant laboratory result
7. Valid ID (patient and representative)
REQUEST FOR HEARING AID
1. Personal Letter Request addressed to Chairman/General Manager of PCSO
2. Audiological Evaluation signed by the Audiometrist independent from the Audiometric Center
3. Three (3) Official sealed Price Quotations from the different hearing aid centers / cochlear implant supplier
4. Social Case Study Report from Local Government Unit (optional)
5. Proof of counterpart from the patient/client
6. Valid ID
REQUEST FOR OPERATION
1. Personal Letter Request addressed to Chairman/General Manager of PCSO
2. Original/Certified True Copy of the Udated Clinical Abstract signed by the doctor with license number and PTR number
3. Official Price Quotation
4. Social Case Study Report from Local Government Unit (optional)
5. Valid ID (patient and representative)

Duration:
Hospitalization for discharge and cases needing urgent treatment
* For P50,000.00 and below - within the day
Regular Cases
* For P50,000.00 and below-four days from the date of interview
Cases above P50,000
* Six (6) days (c/o PCSO Main Office-PICC)
Filing of Application for peritoneal dialysis/hemodialysis/post operative - every 2 months from the date of the last released of Guarantee Letter (GL)
How to Avail of the Service:
STEP
APPLICANT/
CLIENT
1

Submits all documentary requirements

SERVICE
DURATION OF ACTIVITY UNDER
PROVIDER
NORMAL CIRCUMSTANCES
STAGE 1: Evaluation of Application (Day 1)
A. Reviews requirements under the
IMAP guidelines

PERSON IN
CHARGE
Officer-of-the-Day (OD)

FEES

FORM

None

Prescribed
documentary
requirements

A1. For cases with complete

documents (with appointment and
new cases
- Attaches application forms for those with
complete documents.

3 minutes per case

IMAP Application
Form

Note: Priority lane for Senior Citizen and

Person With Disability (PWD)
A2. For cases with incomplete
documents and without appointment
-Provides checklist/orients client with
needed requirement.
-Endorses cases for medical evaluation (for
request of medicines, chemotherapy,
diagnostic and laboratory procedures,
radiotherapy, implant, hearing aid and
cochlear implant, maternity and
psychiatric cases)
-Prepares referral for price quotation (for
medicines and chemodrugs)
-Schedules cases for interview

Requirements
checklist
Endorsement Letter
5 minutes per case

Referral Letter
Schedule Slip

Fills-up the application form and waits

for the number to be called for the
picture-taking

Proceeds to the waiting area and wait

for the number to be called in the
queuing system for interview
Interview phase - proceeds to the
assigned Social Worker

-Validation thru presented ID/authorization

letter
-Picture taking of patient or representative
-Data-banking of all captured information
(picture)

2 minutes per case

-Interviews, assesses and classifies

request and prepares recommendation/
Social Case Study Report (SCSR)

20 minutes per case

-Prepares guarantee letters (GL)

-Reviews and affixes signature in the GL

2 minutes per case (Day 2)

2 minutes per case (Day 2)

-Approves cases not more than P50,000.00

2 minutes per case (Day 3)

-Recommends cases more than P50,000.00

-Approves cases more than P50,000.00 but
within the prescribed authority

2 minutes per case (Day 4-5)

10

None

Social Worker

None

Waits for the assigned Social Worker

to be flashed in the monitor/screen

-Issues claim slip and advises client to

come back on the specified date for the
release of guarantee letter
-Reviews, confirms, and affixes signtaure in
3 minutes per case
the recommendation (SCSR)
STAGE 2 : Processing of Guarantee Letters (Day 2-6)
Encodes transmi
transmittal
2 minutes per
per case
-Encodes
ttal of cases for approval

Photographer

-Receives and data bank approved IMAP

cases

*Cases transmitted to the PICC for

approval of the authorized
signatory
2 minutes per case
(Day 4-for cases P50,000.00 and
below)
(Day 6-for more than P50,000 upon
approval of authorized signatory)

IMAP
Assessment Form

Claim Slip

Supervisor

None

Encoder

None

Supervisor
Division Chief or
her authorized
representative
Department Manager or
his authorized
representative
Asst. General Manager/
General Manager/
Chairperson

Releasing Section
Supervisor

None

None

None

None

Guarantee Letter

Submits claim slip

-Accepts and reviews claim slip

Waits while the guarantee letter is

being retrieved/located

-Locates and retrieves approved

guarantee letters

Releasing of Guarantee Letters

1 minute per case

None

6 minutes per case

None

-Dry-seals the approved guarantee letter

-If the guarantee letters are not yet
available, informs the client that is not yet
available
3

When the patient name is called,

present valid ID

-Validates the identity of the claimant

through the presented ID and records
submitted during the interview

Releasing Section Staff

3 minutes per case

-Releases approved guarantee letter

Note: The processing time is for one client being served at one time . The time is extended when there are more clients.

CERTIFIED CORRECT:

(Sgd.)LARRY R. CEDRO, DMD

OIC-Manager

None

Claim Slip