MANILA (Mabuhay) – The Philippine Health Insurance Corporation (PhilHealth) on Monday denied allegations that the corporation owed 600 private hospitals a total of P600 million in certain backlogs.
Early last week, Private Hospitals Association of the Philippines (PHAPi) president Rustico Jimenez made the allegation, saying that the release of reimbursements was taking at least six months.
PhilHealth president and CEO Alex Padilla, meanwhile, noted that the delay was attributed to connectivity problems due to the corporation’s implementation of a new system – the case-based payment system.
In a press briefing, Dr. Jennifer Raca, PhilHealth’s Benefits Development and Research OIC, explained that there was “miscommunication” between PhilHealth and PHAPi with regards to the definition of backlog.
“The claims processing turn around time for PhilHealth is 60 days. (Which means that) hospitals have 60 days to submit their claims to PhilHealth,” Dr. Raca said.
“If claims are filed beyond the prescribed 60 days or are incomplete and the claims are either Returned To the Hospital (RTH) or denied, it is part of being within the processing time,” she added.
Dr. Raca said that if claims go past 60 day processing time, it is considered a backlog. She also noted that while facilities had 60 days to submit claims, PhilHealth also had 60 days to process the claims.
“Backlog is if (PhilHealth) has not yet processed or not made any decision (if the claims were either good, RTH, or denied) at the end of 60 days from receipt,” she said.
She stressed that as per investigation and reports from regional offices, PHAPi included RTH and denied claims as part of the PhilHealth’s backlogs.
“As to the good claims (which are claim forms filled out properly) we are able to pay it within 60 days,” Dr. Raca assured.
She added that PhilHealth is open to establishing a working committee with the PHAPi to define terms to avoid miscommunication. (MNS)