ARTA urges PhilHealth to simplify review to address backlogs

ABS-CBN News

Posted at Sep 10 2021 12:29 PM

The facade of the PhilHealth Head Office in Pasig City on September 5, 2020. George Calvelo, ABS-CBN News/File
The facade of the PhilHealth Head Office in Pasig City on September 5, 2020. George Calvelo, ABS-CBN News/File

MANILA - The country's anti-red tape body has recommended simplifying PhilHealth's pre-payment review to expedite the processing of claims especially during the pandemic, its official said Friday.

Regional offices should be able to release payments within 60 days, Philippine Anti-Red Tape Authority Secretary-General Jeremiah Belgica told ANC. 

Several hospitals have earlier reported PhilHealth payment backlogs. 

"Our recommendation is to simplify the medical pre-payment and limit it to ministerial documentary submissions and then just take care of the medical review of the diagnosis post-audit," Belgica said.

"The more important one is the medical pre-payment review that they are conducting, a prior assessment before they reimburse, it’s really the main cause of bottleneck there," he added. 

Belgica said they have also recommended the implementation of a debit-credit system where 60 percent is automatically paid while waiting for the evaluation.

To further address backlogs, ARTA has created a task force as a "support group" to help PhilHealth, he said.

The group is composed of key agencies such as the Department of Health (DPH), the Food and Drug Administration (FDA) , the Commission on Audit (COA) and the Department of Information and Communications Technology (DICT), among others.

PhilHealth and the task force will be meeting today, Belgica said.

In August, the Philippine Hospital Association reported the state-run insurer owed each of their members P7 million on average.

President Rodrigo Duterte earlier defended PhilHealth by saying that it was just being "very careful" in processing hospital claims.

Meanwhile, PhilHealth vice president for corporate affairs Shirley Domingo in August said it has about P12.9 billion worth of claims in different stages of processing while denying it has P86 billion in unpaid claims.

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