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Manila Bulletin devider Philippines devider National devider PhilHealth, private hospitals to 'work together' to resolve issues on unpaid claims

PhilHealth, private hospitals to 'work together' to resolve issues on unpaid claims

Published Nov 9, 2021 09:34 pm

(PhilHealth / MANILA BULLETIN)

The Philippine Health Insurance Corporation (PhilHealth) said it met last Monday, Nov. 8, with the Private Hospitals Association of the Philippines, Inc. (PHAPi) to resolve issues with regards to unpaid claims.

PhilHealth and PHAPi agreed to work together “to jointly resolve the claims payments issue and to end public fears over some hospitals' plan of not renewing accreditation next year,” the state-health insurer said in a statement.

"The meeting was agreed to be the first step towards more frequent dialogues and collaborations to address pain points and operational issues that brought challenges to both the Insurer and service providers," said PhilHealth.

It said that among the agreements reached during the meeting include the immediate release of the "second wave of Debit-Credit Payment Method (DCPM) to those hospitals that will signify intention to avail of such."

"Using PhilHealth data, 60 percent of in-process claims shall be released to hospitals that have not yet availed of DCPM, while the remaining 40 percent is released upon processing and reconciliation of initial payment. For hospitals that have already availed of the DCPM, PhiHealth agreed to lower the liquidation threshold to 20 percent of the initial tranche of payment to enable them to immediately avail of the second wave of DCPM," said PhilHealth.

"A corresponding internal memo will be released soon to inform and prepare all regional offices for the second wave of applications," it added.

The state-health insurer also said that both parties "have agreed to work together on the issue of returned and denied claims" by establishing a Technical Working Group.

The Technical Working Group will be composed of representatives from the Philippine Medical Association, Philippine Hospital Association, PHAPi and PhilHealth.

Hospitals also agreed to provide assistance to PhilHealth's information technology (IT) concerns in order "to expedite claims processing," said the state-health insurer.

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