The Philippine Health Insurance Corporation (PhilHealth) has assured its accredited health care providers that it is committed to paying claims that are without deficiencies and compliant to all pertinent policies and requirements of the program.
This was reiterated by the state health insurer amid concerns of the Private Hospital Association of the Philippines, Inc. (PHAPi) over the supposed non-payment of claims to their member hospitals amounting to P6 billion. The Agency clarified that the issue was not presented in the proper perspective as the said hospital association only highlighted the unpaid portion and downplayed that a total of P25 billion has been paid in CY 2020.
PhilHealth said that based on records, it received a total of three million claims from PHAPi member hospitals from January to December 2020, 87 percent of which had been paid amounting to P25 billion, while 5 percent amounting to over P1 billion are in different stages of processing.
However, about 8% of total claims received, estimated to cost around P2.4 billion, were either denied payment or returned to hospitals (RTH) due to deficiencies and/or violations of existing policies and guidelines. Among the common reasons of RTH are unavailability/incompleteness/inconsistency/unreadability of required documents, other documents being required, discrepancies in entries, Claim Form 2 not properly accomplished, and Claim Form 4 with errors, among others.
On the other hand, claims are usually denied due to non-compliance to standard of care (system), filing beyond the 60 days statutory period, late refiling, and non-compensable cases, among others.
“No less than the Filipino people expect us to be prudent in our dealings especially where their funds are involved, this is why we take great pains seeing to it that each and every claim that we pay are consistent with applicable laws and Program regulations,” PhilHealth President and CEO Atty. Dante A. Gierran asserted, adding that as a state insurer, PhilHealth is bound by the auditing rules of the Commission on Audit.
The PhilHealth Chief also recognized the difficult situation being faced by many facilities especially in the midst of the pandemic, saying that “we are committed to pay good claims, but we are bound by law to properly act on deficient ones.” He even guaranteed quicker processing for good claims, citing latest performance record of 39 days on national average against the 60 days provided for by law.
Gierran added that the issue is best addressed through dialogues and reconciliation of records to put things into proper perspective. “Bukas po ang aming tanggapan sa lahat ng rehiyon para mag-reconcile po tayo ng ating claims records. Nakahanda kaming tulungan sila na makapag-comply sa mga polisiya para mabawasan kundi man maiwasan na ang denied o pagbabalik ng claims sa mga ospital.” ###
PHILHEALTH ONLY PAYS “GOOD” CLAIMS; COMMITS PROCESSING AHEAD OF PRESCRIBED TIMEFRAME
The Philippine Health Insurance Corporation (PhilHealth) has assured its accredited health care providers that it is committed to paying claims that are without deficiencies and compliant to all pertinent policies and requirements of the program.
This was reiterated by the state health insurer amid concerns of the Private Hospital Association of the Philippines, Inc. (PHAPi) over the supposed non-payment of claims to their member hospitals amounting to P6 billion. The Agency clarified that the issue was not presented in the proper perspective as the said hospital association only highlighted the unpaid portion and downplayed that a total of P25 billion has been paid in CY 2020.
PhilHealth said that based on records, it received a total of three million claims from PHAPi member hospitals from January to December 2020, 87 percent of which had been paid amounting to P25 billion, while 5 percent amounting to over P1 billion are in different stages of processing.
However, about 8% of total claims received, estimated to cost around P2.4 billion, were either denied payment or returned to hospitals (RTH) due to deficiencies and/or violations of existing policies and guidelines. Among the common reasons of RTH are unavailability/incompleteness/inconsistency/unreadability of required documents, other documents being required, discrepancies in entries, Claim Form 2 not properly accomplished, and Claim Form 4 with errors, among others.
On the other hand, claims are usually denied due to non-compliance to standard of care (system), filing beyond the 60 days statutory period, late refiling, and non-compensable cases, among others.
“No less than the Filipino people expect us to be prudent in our dealings especially where their funds are involved, this is why we take great pains seeing to it that each and every claim that we pay are consistent with applicable laws and Program regulations,” PhilHealth President and CEO Atty. Dante A. Gierran asserted, adding that as a state insurer, PhilHealth is bound by the auditing rules of the Commission on Audit.
The PhilHealth Chief also recognized the difficult situation being faced by many facilities especially in the midst of the pandemic, saying that “we are committed to pay good claims, but we are bound by law to properly act on deficient ones.” He even guaranteed quicker processing for good claims, citing latest performance record of 39 days on national average against the 60 days provided for by law.
Gierran added that the issue is best addressed through dialogues and reconciliation of records to put things into proper perspective. “Bukas po ang aming tanggapan sa lahat ng rehiyon para mag-reconcile po tayo ng ating claims records. Nakahanda kaming tulungan sila na makapag-comply sa mga polisiya para mabawasan kundi man maiwasan na ang denied o pagbabalik ng claims sa mga ospital.” ###
Convenience anywhere, anytime.
PhilHealth offers online payment window for self-paying individuals
The Philippine Health Insurance Corporation (PhilHealth) announced that self-paying members can now pay their health insurance contributions using the recently launched PhilHealth Member Portal.
Using the Portal’s payment management module, they can generate their Statement of Premium Account (SPA) that serves as their billing statement. Self-paying individuals may also select the number of months that they will pay for – from one month to a maximum of three years. After selecting the desired payment range, the module will automatically compute the total contributions due for payment based on their declared income and indicate the due date.
After generating their SPA, the payor then proceeds with choosing the accredited collecting agent (ACA) which will process their payment. Currently, PhilHealth has engaged IPAY-MYEG Philippines, Inc. as its payment partner. Other partners such as PayMaya will soon be added.
The payor will then be directed to the ACA’s domain to make the payment either using Visa or Mastercard credit, debit, pre-paid cards, or GCash. Minimal convenience and service fees will be applied to each transaction. For each successful payment, members will receive their electronic PhilHealth Acknowledgement receipt or ePAR and an e-mail or SMS confirmation.
This payment option will soon be available to Overseas Filipino Workers.
PhilHealth President and CEO Atty. Dante A. Gierran said that this is a well-timed development since many Filipinos still encounter travel restrictions due to the COVID-19 pandemic. “Now, they can conveniently pay their contribution at the comfort of their homes. Hindi na sila magko-commute, gagastos sa pamasahe at pipila sa mga bangko. Sa PhilHealth online payment facility ay ginawa din nating ligtas ang pagbabayad ng kontribusyon.”
Meanwhile, self-paying members who prefer to pay over-the-counter may still do so by presenting their SPA at any PhilHealth office or its accredited collecting agents nationwide. They will be issued the usual hard copy of the receipt as proof of payment. ###