The Cordillera office of the Philippine Health Insurance Corporation (PHIC) started releasing weekly payments of the claims of its health partners to ensure the timely settlement of the corporation’s obligations with the various health facilities.
PHIC regional vice president Dr. Dominga A. Gadgad said that the weekly release of approved claims payment is now a standing policy of the State insurance corporation to address the reported unpaid claims that date back several years ago.
The PhilHealth paid some PhP102.5 million worth of approved claims to the accredited health facilities in the region from January 22-26, 2024.
She claimed that the corporation and the accredited health facilities have reconciled their records on the earlier reported unpaid claims that is why the payments now being remitted is within the prescribed 60-day period for the PHIC to settle its obligations with its partners.
The PhilHealth-CAR official pointed out that for the unpaid claims to the health facilities from 2016-2022, the same had already been located and the documents were reconciled where those that were approved were already paid.
However, she explained that for the claims that were not approved, the concerned health facilities will have to address whatever observations raised within the prescribed 60-day period.
Further, Gadgad added that for the claims that were denied payment by the regional office, the health facilities could still appeal the same to the central office up to the PhilHealth Board before possibly instituting the needed legal action if the same will be denied.
According to her, the supposed issue on unpaid claims by the corporation with various hospitals in the region had been already addressed and that the solution that is now being implemented is the weekly release of approved claims payment to avoid the occurrence of huge backlogs that may also compromise the funds that had been allotted for the said purpose.
She revealed that the weekly payment of claims to the corporation’s partners had been going on smoothly over the past several weeks since it started last month that is why PhilHealth is trying to perfect the system so as not to cause unnecessary delays in the transfer of the payments to the health facilities.
Gadgad urged the accredited health facilities to ensure that the supporting documents of their claims are complete so that the payments could be immediately processed and avoid unnecessary delays because disapproved claims will have to go back to the health facilities for the completion and correction of documents that were submitted.
She assured concerned stakeholders that PhilHealth management is doing its best to facilitate the timely release of claims payment by the corporation’s partners through the existing case rate packages that is why the health facilities should also do their part by ensuring that the documents they are submitting to support their claims are complete and valid.
Moreover, she underscored that the State insurance corporation is also looking into improving its case rates and providing other benefits to the members through the universal health care program following the increase in the contributions of members. By Dexter A. See
