State health insurer PhilHealth has paid a total of P137.6 billion in benefit claims to more than 12,000 accredited health care facilities nationwide from January 1 to October 31, 2024, with a national average turnaround time (TAT) of 25 days.
The said payment is P37.6 billion or 37.7 percent higher compared to P99.9 billion over the same period last year. The national average TAT for claims processing also significantly improved to 25 days which is 35 days faster than the 60 days prescribed under Republic Act No. 10606.
“The steady flow of payments and accelerated processing time are part of our commitment to provide timely and efficient support to our health care partners. The reduced turnaround time has been commended by partner hospitals around the country. It is helping them maintain liquidity, ensuring steady supply of medicines and supplies, salaries for health workers, and continuous improvement of facilities which all translate to better services to members”, PhilHealth president and CEO Emmanuel R. Ledesma, Jr. explained.
The significant improvement in claims payments and faster turnaround time has been recognized by the Agency’s partners and stakeholders. Recently, Dr. Jose P. Santiago, Jr., president of Philippine Hospital Association said during the sidelines of a media event:
“Marami nang pagbabago sa mga nakaraang buwan tungkol sa pagbabayad ng PhilHealth sa mga ospital. Personal na bumibisita (sila) sa mga ospital sa iba’t ibang regions para mag-reconcile at alamin ang mga problema. Dahil dito, nababawasan na ang
negatibong issues sa pagitan ng PhilHealth at mga ospital, at nagkakaroon ng magandang relationship ang PhilHealth at PHA. Ramdam na namin ang pagbabago.”
Sharing the same observation during a recent reconciliation claims conference with hospital leaders, Private Hospitals Association of the Philippines, Inc. President Dr. Jose Rene De Grano thanked PhilHealth for “their initiative to improve claims processing and (making) payment to hospitals better.”
Moving forward, the PhilHealth chief has expressed hope that in due time, they will be able to address the remaining bottlenecks in claims processing through the use of Artificial Intelligence (AI).
He also issued an appeal to healthcare facilities to invest in adequate and properly-trained human resources to ensure the submission of “good” claims within the prescribed filing Period to help ensure claims are complete and in order.
Claims are returned to the hospitals because of discrepancies in entries; incomplete, inconsistent or unreadable documents, and improperly completed claim forms. On the other hand, claims are denied payment due to late filing/re-filing, non-compensable cases, and confinement happened during which the hospital has accreditation issues.
To lower the incidence of returned or denied claims, the state health insurer is reaching out to the hospitals around the country to inform and educate them on the latest claims policies, guidelines and pertinent requirements. It is also conducting claims reconciliation which was earlier validated by the PHA and PHAPi Presidents.
The PhilHealth chief asserted, adding that “PhilHealth is governed by pertinent laws and state auditing rules to ensure that every peso is spent prudently and transparently.”
