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PhilHealth & Private Hospitals: 5 Key Steps to Resolve Unpaid Claims
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.Â
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.Â
“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.
A Step Toward Addressing Unpaid Claims
The Philippine Health Insurance Corporation (PhilHealth) has taken a significant step in resolving long-standing unpaid claims issues with private hospitals. In a crucial meeting held on Monday, November 8, PhilHealth sat down with the Private Hospitals Association of the Philippines, Inc. (PHAPi) to iron out concerns and strengthen their partnership.
One of the primary topics discussed was the settlement of unpaid claims and how PhilHealth and private hospitals can work together to ensure the timely release of payments. The meeting aimed to ease concerns among the public and medical institutions, especially as some hospitals have considered not renewing their accreditation due to these unresolved financial issues.
Implementation of the Debit-Credit Payment Method (DCPM)
To expedite the resolution, PhilHealth committed to the second wave of Debit-Credit Payment Method (DCPM) distribution. This initiative aims to provide immediate financial relief to hospitals struggling with unpaid claims. The updated framework includes the following agreements:
âś… 60% of in-process claims will be released to hospitals that have yet to enroll in DCPM.
âś… The remaining 40% will be distributed once initial payment processing and reconciliation are completed.
âś… PhilHealth will lower the liquidation threshold to 20% for hospitals that already benefited from the first wave of DCPM, allowing them to access additional funding sooner.
Technical Working Group for Claim Disputes
Another key outcome of the discussion was the formation of a Technical Working Group to address returned and denied claims. This group will include representatives from:
âś” PhilHealth
âś” Private Hospitals Association of the Philippines, Inc. (PHAPi)
âś” Philippine Medical Association
âś” Philippine Hospital Association
The goal of this collaboration is to streamline processes, minimize delays, and ensure transparency in claims processing. Hospitals have also committed to assisting PhilHealth in resolving its information technology (IT) challenges, which have contributed to the slow processing of payments.
Ensuring Stability for Hospitals and Patients
The delay in PhilHealth payments has placed significant financial strain on many private hospitals, with some even threatening to discontinue their accreditation. This situation has sparked concern among patients who rely on PhilHealth coverage for their medical expenses.
With this latest agreement, PhilHealth and private hospitals are working toward a solution that not only benefits healthcare institutions but also ensures that patients continue to receive the medical services they need without interruptions.
Looking Ahead: A More Efficient Healthcare System
The partnership between PhilHealth and private hospitals is expected to restore confidence in the country’s health insurance system. By implementing faster payment methods, establishing technical support teams, and leveraging IT advancements, both parties aim to create a more reliable and efficient claims process in the long run.
With these steps in motion, PhilHealth reassures the public that it is committed to fulfilling its obligations, providing financial stability to hospitals, and ensuring quality healthcare services remain accessible for all Filipinos.
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