To ease the burden on hospitals and patients, Philippine Health Insurance Corporation (PhilHealth) President and CEO Dr. Edwin Mercado is looking to improve the efficiency of the state health insurer’s claims processing system.

During a press briefing on Wednesday, Feb. 5, Mercado acknowledged inefficiencies in PhilHealth’s system, particularly in processing hospital reimbursements, and stressed the need for a more streamlined approach.

“Ito ay base lang doon sa karanasan ko bilang isang provider kasi iyon na lang pagpa-process ng claim ilang libo-libo araw-araw – ilang percentage doon ang return to hospital which malaki ang nakukuha namin, may gastusin ho ulit iyon ng pagre-refile (This is based on my experience as a provider. Just the daily processing of thousands of claims—many of which are returned to hospitals—already incurs costs for refiling),” he said.

He added that minor errors, such as misspellings or missing attachments, should not hinder hospitals from receiving their payments.

“Kung mayroon namang halimbawa wrong spelling o mayroon lang kulang na kaunting attachment na hindi naman siya fraudulent eh baka ho gagawin naming proseso ay titingnan natin kung mapapa-improve o mapapabilis iyong filing ng claims (If, for example, there is a wrong spelling or a minor missing attachment that is not fraudulent, we might improve or expedite the claims filing process),” said Mercado.

“Kung maiigsian natin iyo palagay ko naman ay matutuwa ang ospital at makakapag-negotiate tayo na maibaba ang kanilang billing (If we shorten the payment period, I think hospitals will be pleased, and we can negotiate to lower their billing),” he added

Digitalization to speed up processing 

According to Mercado, one of his key initiatives is the digitalization of PhilHealth’s processes to enhance efficiency and transparency.

“Mayroon ng procurement process or bidding na isinasagawa. Hindi ganoon kadali ang pag-shift to a new system (There is already a procurement process or bidding underway. Shifting to a new system is not that easy),” he said.

“Kapag nag-digitize or na-digitalize iyong sistema medyo po mas mapa-flag natin iyong mga potential opportunities (Once the system is digitalized, we will be better able to flag potential opportunities).”