PhilHealth eyes streamlined claims processing

Philippine Health Insurance Corporation (PhilHealth) President and CEO Dr. Edwin Mercado is looking to improve the efficiency of the state health insurer's claims processing system.

Mercado acknowledged inefficiencies in PhilHealth's system, particularly in processing hospital reimbursements, and stressed the need for a more streamlined approach.

He stated that the current payment cycle has been reduced to 25 days.

Mercado explained that minor errors, such as misspellings or missing attachments, should not hinder hospitals from receiving their payments.

He emphasized that these minor errors, if not fraudulent, might be subject to an improved or expedited filing process.

Mercado noted that unpaid claims often stem from issues in how hospitals file their claims, such as incorrect spelling of names, incomplete attachments, or discrepancies between diagnoses and lab test results.

He emphasized that the scrutiny in filling out claims forms by hospitals also contributes to these delays and that the problem is not solely attributable to PhilHealth.