PhilHealth fast-tracks processing of e-claims

The Philippine Health Insurance Corporation in Central Visayas (PhilHealth-7) announced that they are now fast-tracking the processing of claims for their hospitalized members.

“For more than 100 days for the past three years, now it’s only 32 days for its turnaround time in processing claims,” Dr. Roy Ferrer said, acting president and CEO of PhilHealth.

Ferrer has commended the regional vice president of PhilHealth-7, Lourdes Diocson, in implementing this kind of measures, through requiring PhilHealth accredited hospitals to install an automated system.

Diocson, for her part, said that before she was assigned in Central Visayas, the office has already intensified their campaign in automating their system, since it’s the only solution that they have seen to minimize the days of processing claims and hospitals reimbursement.

“We are receiving 5,000 claims a day. If we manually encode these claims, it would really delay the process,” Diocson said.

“So we no longer encode information here at PhilHealth. The hospitals will do the encoding, and then they would just submit the electronic data to us,” she added.

She said that PhilHealth-7 has already issued an advisory requiring hospitals to install their own automated system next year in order to improve their services.

“We’ve already issued an advisory requiring all hospitals for electronic submission (of information) or we go back to the old scenario where we experienced delays on our payments,” she said.

Based on their records, PhilHealth-7 has accredited 60 hospitals, 50 primary care facilities, seven ambulatory surgical clinics, 15 free-standing dialysis clinics, 162 primary care benefit provider, 203 maternity care package provider, 156 TB DOTs providers, 34 animal bite treatment package providers, and four Z-benefit package providers in the whole region.

Aside from this, Diocson said they are also requiring hospitals and other health facilities to open a bank account so that PhilHealth can automatically reimburse them through depositing to their account.

“Every week we are paying P200 million as reimbursement to hospitals. So we will no longer issue checks. Now it’s very fast and very efficient,” Diocson added.

Meanwhile, Ferrer said that they are also planning to have Vicente Sotto Memorial Medical Center (VSMMC) as the pilot area in implementing the Claim Form 4 (CF4).

“Through Claim Form 4, in less than five days we can already process your claims. That’s through e (electronic)-claims,” Ferrer said.

Aside from being quick and accurate, Ferrer said that the system can also identify and validate fraudulent claims.