PhilHealth and private hospitals will ‘collaborate’ to handle unpaid claims difficulties.

 

The Philippine Health Insurance Corporation (PhilHealth) says it met with the Private Hospitals Association of the Philippines, Inc. (PHAPi) on Monday, Nov. 8, to discuss unpaid claims issues.

In a statement, PhilHealth and PHAPi agreed to collaborate “to cooperatively resolve the claims payments issue and to allay public concerns over some hospitals’ plans to not renew accreditation next year,” according to the state-run health insurer. 

The quick distribution of the “second wave of Debit-Credit Payment Method (DCPM) to those hospitals that will express intend to benefit of such,” according to the report, was one of the agreements struck during the meeting. 

“Using PhilHealth data, 60% of in-process claims will be issued to hospitals who have not yet enrolled in DCPM, while the remaining 40% will be released after initial payment processing and reconciliation.” “PhilHealth agreed to lower the liquidation threshold to 20% of the initial tranche of payment for hospitals that have already benefited from the DCPM, allowing them to immediately benefit from the second wave of DCPM,” PhilHealth said.

 “An internal memo will be issued soon to inform and prepare all regional offices for the second round of applications,” the statement continued. Both sides “have agreed to work together on the subject of returned and refused claims” by forming a Technical Working Group, according to the state-run health insurance. Representatives from the Philippine Medical Association, Philippine Hospital Association, PHAPi, and PhilHealth will make up the Technical Working Group.Hospitals also committed to help PhilHealth with its information technology (IT) issues in order to “speed up claims processing,” according to the state-run health insurer.

 

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