PhilHealth engages hospitals on payment of COVID-19 claims

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BAGUIO CITY – The Cordillera office of the Philippine Health Insurance Corporation (PhilHealth) continues to conduct dialogues with the administrators of private and government hospitals to ensure the timely processing and payment of their claims from Corona Virus Disease (COVID) 2019 patients confined in the said health facilities.

PhilHealth-CAR Acting Regional Vice President Dr. Dominga A. Gadgad stated that the agency had been time and again reminding hospital administrators to ensure the completeness of the documents supporting their claims to avoid unnecessary delays in the processing and subsequent payment of the same but there are still instances being uncovered that there are still health facilities that submit incomplete documents for such purpose.

She added during the regular monthly City Hall Hour program that what the agency is doing is to ensure that the claims being paid to the hospitals are legitimate because they do not want that the money of the members will be wasted as it is also their duty to protect the funds that come from the members’ contributions.

The PhilHealth-CAR official disclosed that based on the agency’s records, the period when hospitals file their claims with the agency range from 27 to 80 days upon the discharge of the confined patients, thus, the need for the hospital administrators to effectively and efficiently address the same to prevent the complained delays in the processing and payment of such claims.

Gadgad claimed that there are no more pending claims of hospitals with the agency, especially on COVID, because the claims were either paid, denied, referred back to the hospital for the completion of lacking requirements or referred to the legal office to ascertain the legitimacy of the claims to avoid repeated allegations from hospitals that the PhilHealth is delayed in the settlement of such claims.

According to her, one of the reasons for the delayed processing of the claims is the alleged incomplete attachments of the same being submitted by the hospital, especially on the itemized billing of the patients, thus, the same is being referred back to the hospital for the completion of the lacking documents before being assessed and evaluated.

Gadgad urged hospital administrators to ensure the completeness of their claims being submitted to the agency for processing and payment to prevent unnecessary delays in the release of the payments due to health facilities as the agency also understands that the hospitals need the funds to sustain their operations, especially during the pandemic considering their critical role in the treatment of individuals who contract the deadly virus.

She pointed out that the agency is simply complying with the existing circulars governing the processing and the payment of COVID claims of accredited community isolation units and health facilities that is why it would be unfair and unfounded to accuse them of delaying the payment of the filed claims to ensure that such claims are legitimate and pursuant to the issuances by concerned government agencies.

Gadgad stipulated that what is important is that there are hospitals that recognize their fault in the submission of their incomplete claims and that appropriate steps had been undertaken to prevent the occurrence of similar incidents in the future.

By Dexter A. See

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