Hospitals threaten ‘holidays’ over slow Philhealth claims payment

By Gaby Keith 

BAGUIO CITY – An association of nationwide private hospitals threatened to  implement “forced holidays” to make the Philippine Health Insurance Corporation regional office  (Philhealth-CAR) hasten payment of legitimate claims of hospitals

Mayor Mauricio Domogan has signed two separate city council resolutions urging Philhealth-Cordillera Administrative Region to hasten payment of legitimate claims of hospitals in the Summer Capital and requesting the agency to conduct a massive information dissemination on electronic claims (eClaims)  to its partner hospitals here.

Resolution No. 165 said the city council in its June 4, 2018 regular session invited the Philhealth regional director and authorized representatives of private hospitals in the city relative to the alleged threat of the Private Hospitals Association of the Philippines, Inc. for a hospital holiday in view of the unpaid debts of Philhealth that has caused concern to local residents particularly Philhealth members .

Upon deliberation on the matter and presentation of issues, the local legislature deemed it necessary and of utmost importance to urge Philhealth-CAR to process payments of legitimate claims of local hospitals.

 Meanwhile, resolution no. 166 states that the agency has directed its accredited health care institutions (HCIs) to shift to eClaims to achieve better efficiency in claims processing and improve claims data integrity.

Philhealth defines eClaims as an interconnected modular information system for claim reimbursement transactions that starts from the time a patient intends to avail of Philhealth benefits at accredited HCIs and ends when the claim is paid.

The agency explained that partner HCIs can benefit from using the eClaims since they can readily check on the member’s eligibility, submit claims online and track claim status thus  HCIs are assured of efficiency in recording, transmitting and processing of their claim documents while saving up on physical space in storing voluminous documents.

For Philhealth, the implementation of the eClaims also helps in fraud detection, monitoring and prevention.

“While Philhealth first introduced the eClaims approach in 2012, it granted HCIs ample time to prepare for the shift and became mandatory on January 1, 2018.  However, the invited resource persons still find difficulty in its implementation,” the resolution stated.