PhilHealth working ‘double time’ to process P25.6B in unpaid hospital claims

State-run Philippine Health Insurance Corp. (PhilHealth) on Thursday said it was addressing the billions of pesos worth of unpaid claims by several hospitals.

In a statement, the state health insurer said its president and CEO Dante Gierran directed PhilHealth's chief operating officer and regional vice presidents to address the issue “through constant dialogues and reconciliation of figures with hospital representatives at the regional level.”

“The allegations of huge payables of the corporation were dispelled after these reconciliation meetings,” it said.

Citing its records, PhilHealth said it paid a total of P166 billion for some 13.6 million claims, or 76.4% of the almost 18 million claims received from its accredited government and private hospitals in the country from 2020 to June 30, 2021.

The state-run firm said it “is working double time to process the remaining 12% amounting to P25.6 B which are in varying levels of processing in its offices.”

It said that some 8% of total claims received were returned to hospitals (RTH) for compliance with identified deficiencies while 3% were denied due to non-compliance and various violations of existing rules and regulations.

Of the total claims received during the said period, the state health insurer said almost 10 million claims were from accredited private hospitals, of which, 8.2 million or 82% amounting to almost P96 billion have been paid while over 892,000 claims amounting to P14.4 billion are still under process.

“The Corporation would like to clarify that the P6.3 billion paid to 206 hospitals as claimed by the PHAPi in recent news reports refer to the partial payments made by PhilHealth under the Debit-Credit Payment Method (DCPM) for hospitals with COVID cases in IATF identified critical areas during the initial phase of implementation,” the PhilHealth said.

The seeming discrepancy in figures between PhilHealth and the hospitals may be due in large part to differences in accounting treatments, it said.

“During the claims data reconciliation meetings with a number of hospitals, it was noted that hospitals have been including denied and returned-to-hospital claims in their accounts receivables while PhilHealth recognizes only good claims as its payables pursuant to prevailing government accounting rules and regulations,” it said.

“This accounting practice was earlier validated during the House Committee on North Luzon Growth Quadrangle hearing with hospitals and PhilHealth in June of this year,” it added.

The state-run firm said it has employed several strategies to fast track the remaining claims being processed in its offices.

“PhilHealth is in constant dialogues with hospitals in the regions, even as it intensifies its efforts in the NCR where COVID-19 cases are high,” it said. —NB, GMA News