PhilHealth and hospitals make headway on claims issues

In a breakthrough development, the Philippine Health Insurance Corporation (PhilHealth) and a number of private hospitals led by Private Hospitals Association of the Philippines, Inc. (PHAPi) President Dr. Jose Rene de Grano have met early today to jointly resolve the claims payments issue and to end public fears over some hospitals’ plan of not renewing accreditation next year.

Present in the meeting were PhilHealth officials led by its PCEO Atty. Dante A. Gierran, Dr. Jose Rene de Grano, The Medical City PCEO Dr. Eugene Ramos; St. Luke’s Hospitals PCEO Dr. Art dela Pena; and Mt. Grace Hospitals, Inc. PCEO Carlos C. Ejercito and Executive VP and COO Rhais Gamboa.

The meeting was agreed to be the first step towards more frequent dialogues and collaborations to address pain points and operational issues that brought challenges to both the Insurer and service providers.

Among the agreements reached include the immediate release of the second wave of Debit-Credit Payment Method (DCPM) to those hospitals that will signify intention to avail of such.

Using PhilHealth data, 60% of in-process claims shall be released to hospitals that have not yet availed of DCPM, while the remaining 40% is released upon processing and reconciliation of initial payment.

For hospitals that have already availed of the DCPM, PhiHealth agreed to lower the liquidation threshold to 20% of the initial tranche of payment to enable them to immediately avail of the second wave of DCPM.

Gierran vowed that a corresponding internal memo will be released soon to inform and prepare all regional offices for the second wave of applications. In addition the “Undertaking” that hospitals sign and submit as attachment to qualify for DCPM payments shall be amended based on suggestions from the hospitals.

The hospitals have likewise emphasized the need for regularity and predictability of payments to ensure uninterrupted hospital operations. A series of steps to solve the issue given PhilHealth’s current challenges was submitted for consideration of the State Agency.

Moving forward, both parties have agreed to work together on the issue of returned and denied claims through a Technical Working Group composed of representatives from the Philippine Medical Association, Philippine Hospital Association, PHAPi and PhilHealth.

Responding to the appeal of PCEO Gierran for support on its IT concerns, the hospitals led by Mt. Grace hospitals agreed to provide assistance in order to expedite claims processing.



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