PhilHealth says delay in payments due to incomplete data, review of claims

The Philippine Health Insurance Corporation (PhilHealth) has attributed the delay in the release of funds to hospitals and the Philippine Red Cross (PRC) on incomplete data and the tedious review of claims, amid the recent surge in COVID-19 cases across the country.

PhilHealth spokesperson Rey Balena on Monday responded to PRC Chairman Senator Richard Gordon's statement that the state insurer owes some P822 million for COVID-19 tests.

"Of the P800 million, P272 million are with deficiencies and needing compliance/correction by the PRC. We cannot pay these in accordance to our rules and that of COA's. The rest are in process and we will release soon," he said in a mobile message.

Among the deficiencies cited by Balena are incomplete names, foreign-sounding names, names with special characters, futuristic birthdays, and non-compliance to the five basic personal identifiable information.

"Just like with our other accredited providers, dapat maging maingat po sa entries sa claims dahil ito po ang documentation na pinagbabatayan ng processors kung maayos o kaya ay hindi dapat bayaran," he explained.

[Just like with our other accredited providers, we need to be careful on the claims entries because this documentation is the basis of processors on whether they should be paid or not.]

Balena also responded to the Philippine Hospital Association's (PHA) claim that some hospitals have yet to receive payments since March 2020, saying the agency understands the predicament of its hospital partners given the current situation.

"Prudence dictates that in order to protect the fund of the members, PhilHealth sees to it that each and every claim that it pays are consistent with applicable laws and program regulations and guidelines," he said.

"We encourage our hospitals to be more diligent in ensuring that they file complete and not deficient claims and return them within the prescribed period for PhilHealth to immediately act on them," he added, noting that PhilHealth is open to dialogues with the PHA on the matter.

Under its mandate, PhilHealth is tasked to administer the National Health Insurance Program which aims to provide health insurance coverage and ensure affordable, acceptable, available, and accessible health care services for all citizens of the Philippines. — BM, GMA News