PhilHealth reimburses 83.48% of filed benefit claims in 27 days

PhilHealth Regional Office (PRO)-6 said it has paid 83.48% of good and complete claims in Western Visayas in the average of 27 days in 2020 to 2021.

In a statement, PRO-6 said it processed and paid 1,197,148 out of the 1,434,130 claims in the amount of P9,367,479,265.58.

Approved for payment were 20,594 or 1.43% of claims amounting to P109,550,908.40, while 5.79% or 83,140 benefit claims equivalent to P447,202,635.89 are in-process.

However, several filed claims were returned to hospitals (RTH) and denied for payment due to discrepancies in claims filing and non-compliance to the rules and procedures set forth by the state-insurer.

A total of 109,068 (7.61%) in the amount of P689,978,723.00 were returned to the healthcare institutions for compliance of requirements while 24,180 (1.69%) claims amounting to P181,632,786.00 have been denied.

Returned and denied claims that will be re-filed or appealed will undergo validation and re-processing before payment.   These are not considered arrears of the Corporation while not yet approved for payment.

PhilHealth reminds healthcare institutions to promptly submit its claim in order for it to be validated and paid at the soonest possible time.

Data shows that the average turn-around-time for accredited HCIs to submit their claims is at 79 days upon discharge of patient while PhilHealth processes good and complete claims in just 27 days.