Philippine Health Insurance Corporation (PhilHealth) President Dr. Edwin Mercado suggests reviewing the process for settling unpaid hospital claims, citing potential issues with hospitals' filing procedures. He acknowledges that while the payment cycle has been shortened to 25 days, unpaid claims often arise from hospitals' meticulous review during the filing process.
Philippine Health Insurance Corporation (Phil Health ) President and Chief Executive Officer (CEO) Dr. Edwin Mercado indicated on Wednesday that the process for swiftly settling unpaid hospital claims may require reevaluation. 'Based on the latest data I read, the payment cycle has been shortened to 25 days.
Unpaid claims frequently stem from hospitals' meticulous scrutiny during the filing process, so it might be necessary to revisit these procedures,' Mercado stated at a Palace press briefing. He further explained, 'Reasons for flagging down claims include, as I mentioned earlier, spelling errors in names, missing attachments, and a mismatch between the diagnoses and lab tests conducted. The scrutiny in completing the claims form also plays a role. The issue isn't solely attributed to PhilHealth.' Mercado also emphasized that healthcare providers should diligently rectify their claims processing to minimize delays.In January, a congressional inquiry into the state insurer's P59.6 billion in unpaid hospital claims was proposed in the House of Representatives. Cagayan de Oro Representative Rufus Rodriguez initiated the call through House Resolution 2173, asserting that the non-payment of dues has led to 'the partial closure of certain medical services at hospitals and, in some cases, the complete closure of hospitals.' Rodriguez maintained that PhilHealth possesses sufficient financial resources to settle its outstanding obligations. He cited figures such as the P150 billion surplus reserve funds, the anticipated P203 billion in premium collections for 2025, the P80 billion in unfunded allotments for 2023 and 2024, and the P21 billion in unreleased appropriations.Mercado confirmed that he is currently analyzing PhilHealth's corporate budget to ascertain its financial standing.
PHILHEALTH UNPAID CLAIMS HOSPITAL CLAIMS PAYMENT CYCLE HEALTHCARE PROVIDERS
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