P320-M claims of GenSan hospitals out by Oct. 31: PhilHealth - TrueID

P320-M claims of GenSan hospitals out by Oct. 31: PhilHealth

Philippine News AgencyOctober 19, 2021

GENERAL SANTOS CITY – The Philippine Health Insurance Corp. (PhilHealth) is targeting to release by the end of October around PHP320 million in pending reimbursement claims by private hospitals here.

Nol Valila, head of the PhilHealth-Local Health Insurance Office here, said Tuesday they are currently working on completing the processing of at least 7,200 claims by Oct. 31 based on an agreement last week with concerned hospitals.

He said the amount is part of the PHP437-million “good claims” or those with complete documentation submitted by the health care providers.

As of Tuesday, he said they already processed some PHP49 million worth of claims of local hospitals that will be credited to their accounts within the week.

“We are currently fast-tracking the processing of these claims...Next week, we will be coping up with the remaining number of claims as promised,” Valila said in a “question hour” during the city council’s regular session.

He was responding to a query from city councilors over a statement earlier released by the Private Hospitals Association here regarding the delayed payment of their claims that has reportedly reached PHP834,532,820.98.

The hospitals said the mounting unpaid claims have already affected their operations and might eventually result in the collapse of the local health care system, which is still trying to reel from the coronavirus disease 2019 (Covid-19) pandemic.

The statement was signed by officials and representatives from the Auguis Clinic and Hospital, General Santos Medical Center, Socsargen County Hospital, General Santos City Doctor’s Hospital, Mindanao Medical Center, Sarangani Bay Specialists Medical Center Inc., St. Elizabeth Hospital Inc., and Diagan Cooperative Hospital.

Valila said they held a consultative meeting last week with representatives of the eight private hospitals to thresh out the problems regarding the delayed payments.

He said they clarified with them that only around PHP750 million of the PHP834 million claimed by hospitals is still pending.

Of the PHP750 million, only PHP437 million have proper documents while the rest, amounting to over PHP300 million, were either denied or returned to the hospitals.

These claims were returned by PhilHealth-Region 12 to the hospitals due to the lack of supporting documents.

Dr. Hector Zenon Leonardo Malate, acting vice president of PhilHealth-Region 12 (Soccsksargen), said last week that the returned claims need to be refiled by the hospitals and are not considered as “due and demandable” pending their compliance.

From January 2020 to October 9 this year, he said they have already processed and released some PHP1.159 billion in claims, including those involving Covid-19 cases, to the concerned hospitals.

He said the settled amount represented 61 percent of the 136,731 reimbursement claims amounting to P1.9 billion that were submitted to the agency during the period.

Meantime, aside from expediting the processing of the claims, Valila said they have agreed to immediately release the “return to hospital” claims to the concerned health care institutions in Region 12.

He said the agency will also issue a regional advisory to all health care providers stating the clarificatory provisions in the implementation of Covid-19 in-patient benefit packages “for uniform guidance and application of policies.”

He said South Cotabato 1st District Rep. Shirlyn Bañas-Nograles, whom they engaged in a separate consultation, promised to provide them with additional manpower to assist the “reconciliation process” of the returned claims.

At least six workers committed by the lawmaker will start working with them within the week, he said.

“We will also conduct regular dialogues with health care institutions and medical society (groups) to address the issues and concerns with regards to the payment of claims,” he added. (PNA)

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