PhilHealth: Only 12% remaining in unpaid COVID-19 claims

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Metro Manila (CNN Philippines, August 6) — State health insurer Philippine Health Insurance Corporation said it is "working double time to process" the pending hospital claims for COVID-19 cases.

"The Corporation is working double time to process the remaining 12% amounting to ₱25.6 billion, which are in varying levels of processing in its offices," the agency said in a statement.

PhilHealth issued the statement after several hospitals said the unpaid claims may affect their operations amid preparations for a possible surge in COVID-19 cases driven by the more transmissible Delta variant.

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Citing its records, PhilHealth said it already paid ₱166 billion for 13.6 million claims, or 76.4% of the almost 18 million claims it received from its accredited government and private hospitals across the country from last year until June 30, 2021. During this period, 10 million claims came from private facilities and almost P96 billion were already paid to their 8.2 million claims, while the payment of P14.4 billion to 892,000 claims is under process.

About 8% of the claims had deficiencies and were returned to hospitals for compliance, while 3% were denied due to non-compliance and other violations, PhilHealth said.

The state health insurer also clarified that the P6.3 billion paid to 206 hospitals, as claimed by the Private Hospitals Association of the Philippines, are partial payments the agency made under the Debit-Credit Payment Method for hospitals with COVID-19 cases. It said discrepancies may be due to differences in accounting methods.

"During the claims data reconciliation meetings with a number of hospitals, it was noted that hospitals have been including denied and returned-to-hospital claims in their accounts receivables while PhilHealth recognizes only good claims as its payables pursuant to prevailing government accounting rules and regulations. This accounting practice was earlier validated during the House Committee on North Luzon Growth Quadrangle hearing with hospitals and PhilHealth in June of this year," it explained.

The state health insurer also assured that it is making efforts to fast-track the processing of the claims and is conducting dialogues with hospitals in all parts of the country.

"The allegations of huge payables of the Corporation were dispelled after these reconciliation meetings," it added.