The Philippine Health Insurance Corporation (PhilHealth) said it is continuing to find ways to ensure that claims are being processed amid reports that it has not paid claims from private hospitals.
In a statement, PhilHealth said it has paid a total of P114.6 billion to accredited hospitals in 2018 and P 97.4 billion in 2019, and has disbursed more than P 43 billion so far this year.
Philhealth was responding to a claim by the Private Hospital Association of the Philippines Inc. (PHAPI) that at least 300 hospitals could close due to delayed payments.
The claim was highlighted in a House Resolution issued by Cagayan De Oro Rep. Rufus Rodriguez that orders the health insurer to pay P 18 billion in unpaid claims.
PhilHealth said that while the Coronavirus disease 2019 (Covid-19) pandemic has affected hospitals in the country because of declining admissions, it should not be the only reason for unpaid claims.
It said that it has paid the University of Santo Tomas Hospital P400 million from 2019 until May 2020, and has advanced P85 million for its Covid response.
“In its letter dated May 5, 2020, the USTH said that it is reconciling their claims records with PhilHealth’s.” it said.
PhilHealth also said it has introduced different methods to manage the claims of its member-hospitals, such as the “eClaims” system and the utilization of cloud infrastructure to inform hospitals of claims that “failed the first level of data validation tests.”.
“Currently, it is also designating accounts reconciliation officers to support hospitals in claims records reconciliation,” it added, noting that it was the agreed-upon solution with the PHAPI and Senate Committee on Health and Demography Chairman Sen. Christopher Lawrence “Bong” Go.
PhilHealth has urged hospitals to reconcile their claims records with their regional offices so they could be updated on the status of their claims.