PhilHealth assures payment of unpaid hospital claims

Philippine Health Insurance Corporation (PhilHealth) (MANILA BULLETIN)

The Philippine Health Insurance Corporation (PhilHealth) has assured that it is now working to address the complaints of hospitals in claims processing delays.

Citing its records, PhilHealth said it has already paid a total of P166 billion for the 13.6 million claims or 76.4 percent of the 18 million claims it received last year to June 30, 2021 from its accredited government and private hospitals in the country.

“The Corporation is working double time to process the remaining 12 percent amounting to P25.6 billion which are in varying levels of processing in its offices,” said the state-health insurer in a statement.

PhilHealth said that at least eight percent of “total claims received were returned to hospitals for compliance with identified deficiencies.”

Meanwhile, three percent were “denied due to non-compliance and various violations of existing rules and regulations,” it said.

“The Corporation has employed several strategies to fast track the remaining claims being processed in its offices,” said PhilHealth.

“PhilHealth is in constant dialogues with hospitals in the regions, even as it intensify its efforts in the NCR where COVID-19 cases are high,” it added.

Moreover, the state-health insurer also clarified that the P6.3 billion paid to 206 hospitals as claimed by Private Hospitals Association of the Philippines Inc. (PHAPi) “in recent news reports refer to the partial payments made by PhilHealth under the Debit-Credit Payment Method (DCPM) for hospitals with COVID cases.”

The discrepancies may be attributed to differences in “accounting treatments,” it said.

“During the claims data reconciliation meetings with a number of hospitals, it was noted that hospitals have been including denied and returned-to-hospital claims in their accounts receivables while PhilHealth recognizes only good claims as its payables pursuant to prevailing government accounting rules and regulations,” said PhilHealth.

“This accounting practice was earlier validated during the House Committee on North Luzon Growth Quadrangle hearing with hospitals and PhilHealth in June of this year,” it added.