PhilHealth disburses P137.6B in 2024, improves claims processing

The Philippine Health Insurance Corporation (PhilHealth) announced the release of P137.6 billion in benefit claims to over 12,000 accredited healthcare facilities nationwide from 1 January to 31 October, 2024. This marks a 37.7% increase compared to the P99.9 billion disbursed during the same period in 2023. The average turnaround time (TAT) for claims processing improved significantly to 25 days, well ahead of the 60-day period prescribed under Republic Act No. 10606.

PhilHealth President and CEO Emmanuel R. Ledesma Jr. emphasized the impact of faster claims processing.

“The steady flow of payments and accelerated processing time are part of our commitment to provide timely and efficient support to our health care partners. The reduced turnaround time have been commended by partner hospitals around the country. It is helping them maintain liquidity, ensuring steady supply of medicines and supplies, salaries for health workers, and continuous improvement of facilities which all translate to better services to members," he said.

The initiative has been well-received by healthcare partners. Philippine Hospital Association President Dr. Jose P. Santiago Jr. noted, "Marami nang pagbabago sa mga nakaraang buwan tungkol sa pagbabayad ng PhilHealth sa mga ospital. Personal na bumibisita (sila) sa mga ospital sa iba't ibang regions para mag-reconcile at alamin ang mga problema. Dahil dito, nababawasan na ang negatibong issues sa pagitan ng PhilHealth at mga ospital, at nagkakaroon ng magandang relationship ang PhilHealth at PHA. Ramdam na namin ang pagbabago.”

(Much has changed in the past few months with PhilHealth's disbursements to hospitals. They personally visit hospitals in different regions to reconcile accounts and understand the problems we face. Because of this, negative issues between PhilHealth and hospitals are decreasing, and PHAs and Philhealth maintain good relations. We feel the difference.)

Similarly, Private Hospitals Association of the Philippines, Inc. President Dr. Jose Rene De Grano commended PhilHealth for addressing bottlenecks in claims processing.

Looking ahead, PhilHealth is exploring Artificial Intelligence (AI) technology to further streamline claims handling.

“We have just completed a study conducted by experts on how AI can aid us in receiving and processing claims at break-neck speeds never before seen," Ledesma announced. “We are confident that with the support of our healthcare partners, this will happen in the very near future."

PhilHealth also continues to conduct outreach initiatives to educate hospitals on claims policies and requirements, aiming to reduce denied or returned claims caused by discrepancies or incomplete documentation.

Ledesma also issued an appeal to healthcare facilities to invest in adequate and properly-trained human resource to ensure the submission of “good” claims within the prescribed filing period. “This will help ensure claims are complete and in order, free from deficiencies, incomplete documents or signatures, and unreadable attachments, among other reasons," he enumerated.

To lower the incidence of returned or denied claims, the state health insurer is reaching out to the hospitals around the country to inform and educate them on the latest claims policies, guidelines and pertinent requirements. It is also conducting claims reconciliation which was earlier validated by the PHA and PHAPi Presidents.