ILOILO City – The Philippine Health Insurance Corporation (PhilHealth) has expedited the processing of claims payments to its partner healthcare facilities across Western Visayas this year.
From January 1, 2024, to June 30, 2024, PhilHealth Region 6 has disbursed P3,995,802,866.97 for 453,016 claims filed, representing 96 percent of their total payable claims.
The breakdown of the payments per province is as follows:
* Aklan – P310,825,344.96
* Antique – P216,113,030.25
* Capiz – P347,674,063.71
* Guimaras – P54,896,327.03
* Iloilo – P1,554,460,360.52
* Negros Occidental – P1,511,833,740.50
“For the 2024, we have addressed 96 percent of the cases that were re-filed and filed within the year, and the remaining three percent still in process are claims that have issues needing further attention, which is why they have not yet been processed,” explained Dr. Rodalyn E. Lagalangan, Medical Specialist IV of the Benefit Administration Section of PhilHealth Region 6.
Lagalangan cited the turn-around-time (TAT) of 19 days for claims without issues and complete documentation as a key factor for the expedited payments, which is significantly faster than the mandated 60 days by law.
However, Dr. Lagalangan assured that efforts are ongoing to achieve 100 percent claims payment by coordinating with healthcare facilities and institutions to reconcile claims with issues and concerns.
“We also conduct regular orientations and updates for our personnel who are hands-on with case processing. During office hours, we address their concerns, ensuring open communication and proper coordination with our service providers as well as our members,” added Lagalangan.
The primary cases processed for payments in healthcare facilities include hemodialysis, pneumonia, chemotherapy, maternity care packages, and newborn care packages.
In the region, PhilHealth Region 6 partners with 68 hospitals, 31 infirmaries, six ambulatory surgical clinics, 33 freestanding dialysis centers, 145 maternity care providers, and 111 TB DOTs (directly-observed therapy, short-course) among others.
Nationally, PhilHealth is pleased to announce that it has paid out P74.95 billion in claims, which is 16 percent higher than the P64.36 billion recorded during the same period in 2023.
To assist hospitals in speeding up the reconciliation of claims, PhilHealth has created the Financial Management and Reporting Enhancement Program (PinMaREP), which allows direct engagement with hospitals to reconcile their books with hospital account books.
Additionally, PhilHealth recently signed an agreement with a global IT solutions provider to test a special software employing Artificial Intelligence to enhance the process of PhilHealth reimbursements. This initiative aims to reduce the processing time for claims and minimize the incidence of claims being returned to hospitals due to deficiencies./PN