Hospitals urged to submit good claims to ensure faster payments

MANILA – The Philippine Health Insurance Corporation (PhilHealth) on Thursday reminded hospitals and health facilities to submit good claims to receive payments due their services.

In a public advisory, the state insurer said its national turnaround time (TAT) on good claims for 2024 has improved to 24 days from 34 days for 2023.

"This only shows our continuous commitment to processing and payment of good claims ahead of prescribed 60 days TAT," it said.

Good claims are claims without deficiencies and compliant to all pertinent policies and requirements of the National Health Insurance Program and the Universal Health Care.

"While our benefit payout for CY (calendar year) 2024 increased by 22.71 percent from PHP119 billion in CY 2023 to PHP165 billion for CY 2024, however about 5.3 percent of the claims received, estimated to cost around PHP10 billion were either denied payment or returned to hospitals due to deficiencies or violations of existing policies and guidelines," the PhilHealth said.

Last week, PhilHealth President and Chief Executive Officer Edwin Mercado said the state insurer will start reprocessing 1.1 million denied claims amounting to PHP8.8 billion from Dec. 1, 2018 to Dec. 31, 2024.

Health facilities are urged to submit good claims earlier than the prescribed 60-day period to further reduce and ensure early release of payment.

PhilHealth vowed to work closely with healthcare providers and other partners through continuous reconciliation to maintain the quality of service and improved financial support value for its members. (PNA)