THE Philippine Health Insurance Corp (PhilHealth)-6 regional office has paid more than P2 billion in benefit claims in the first quarter of 2018.
The amount covered 197,244 good claims processed by PhilHealth, which is 27% higher compared to claims in 2017 totaling 155,312.
According to Dr. Bernadette L. Reynes, PhilHealth-6 Officer-in-Charge, despite the substantial number of benefit claims submitted by hospitals, processing is within the allowed statutory period of 60 days as provided for in the IRR of the National Health Insurance Act of 1995.
“Our data on claims processing reveal an improved turn-around-time (TAT) brought about by the shift from manual to electronic claims processing,” said Dr. Reynes. “We are paying claims of hospitals using the manual mode of transmission within 46 days while hospitals which submit claims electronically are paid at 35 days,” she added.
PhilHealth e-claims system is an interconnected modular information system for claim reimbursement beginning from the time a patient signifies the intention of availing PhilHealth benefit and ends when the claim is paid. It aims for greater efficiency in claims processing and improved data integrity of claim benefits.
At present, there are 133 facilities as of March 2018 with engaged IT provider that affords them to check patient’s eligibility, submit claims online and even verify the status of processing.
Payment of PhilHealth benefit claims has also advanced to paperless means, eliminating check preparation through Auto Credit Payment Scheme – a payment mechanism wherein claim reimbursements are directly credited to the hospitals’ bank account.
However, PhilHealth noted that 12.67% of claims received in 2017 were denied and returned to hospitals (RTH). Common reasons for its denial and RTH include confinement not within hospital accreditation period, expired validity of coverage, filed beyond 60 days, violation of the rule in a single period of confinement, not properly accomplished Claim Forms and Statement of Account. Hospitals are also reminded to submit compliance to returned claims within 60 days upon receipt.
“We remain steadfast in fulfilling our commitment to the public, ensuring that no Filipino is left without health insurance coverage and that each member only gets the best our country can offer in terms of health care services,” said Dr. Reynes.
Leading the claims in 2017 are hemodialysis with 99,077 cases; pneumonia moderate risk with 70,835; and 57,864 claim for normal newborn care package, with a total benefit payment of P1.570 Billion. (Public Affairs Unit/PhilHealth 6)