PhilHealth claims processing improves

MANILA, Philippines - The Philippine Health Insurance Corp. (PhilHealth) reported yesterday an improvement in its claims processing system as seen in the increase of claims from 340,000 to 450,000 per month.

Late last year, PhilHealth began addressing the issues of delayed claims payments and claims backlog by fixing its management and Information Technology (IT) system.

“PhilHealth believes that a shift to electronic claims processing are key to attain claims efficiency,” PhilHealth president and CEO Dr. Eduardo Banzon said.

PhilHealth also attributed its success to the proactive training and coordination of its regional offices with their respective partner hospitals.

During a reconciliation procedure with partner hospitals last year, they found that the so-called backlogs or assumed denied receivables were actually mislabeled claims that were not tagged/recorded accordingly by the hospitals.

“From these experiences, it is apparent that IT systems have to be improved from both PhilHealth’s and provider’s end,” Banzon noted.

As of June this year, PhilHealth was able to decrease the turnaround time from more than 60 days to 48 days and this trend has been consistent in all regional offices and not just in Region V, VI and NCR.

The percentage of claims paid beyond 60 days has also been reduced to 26 percent.

Currently, there are 80 hospitals connected to PhilHealth e-claims eligibility check module but they plan to mobilize all level 3 and 4 hospitals to comply with their electronic system by end of 2012 to speed up reimbursements.

“We won’t stop pushing until optimal levels are achieved,” Banzon said.