ARTA urges PhilHealth to conduct medical post-payment review

The Anti-Red Tape Authority (ARTA) on Thursday urged the Philippine Health Insurance Corporation (PhilHealth) to conduct a medical post-payment review amid its unpaid claims to hospitals.

During the Laging Handa briefing, ARTA director-general Jeremiah Belgica said they found the medical prepayment review to be too long.

“Ang nakita namin diyan is ‘yung kanila ngang medical pre-payment review ay ito ay tumatagal at humahaba. Kaya ang aming recommendation ay gawin nilang post ang kanilang pag e-evaluate diyan,” he said.

(We saw that their medical prepayment review tends to take too long. So we recommended for them to instead conduct a post evaluation.)

In 2019, PhilHealth started to require a medical prepayment review for claims of its members seeking treatment in hospitals, where claims that are not compensable or non-compliant will not be processed.

“Ibig sabihin, bayaran muna nila and then they could continue the evaluation of medical diagnosis. Ang kailangan na lang muna i-submit ng mga ospital ay ‘yung kanilang documentary requirements,” he added.

(This means they must first pay and then they could continue the evaluation of the medical diagnosis. The hospitals only need to first submit the documentary requirements.)

Belgica said ARTA has created support teams with the Department of Information and Communications Technology, Department of Health, and Health Professional Alliance.

“Inimbita din namin ang COA as a resource para magbigay ng suporta at para mapabilis at malabas na mismo ang mga kailangang bayaran,” he said.

(We also invited COA as a resource to give support and to hasten the release of the payment.)

As of August 17, PhilHealth spokesperson Shirley Domingo said P12.9 billion worth of reimbursements were pending with PhilHealth.

PhilHealth has issued a circular on temporary suspension of payments on claims that are currently under investigation, which groups have decried. The agency later put a hold on the circular.—AOL, GMA News