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PhilHealth 6 pays P9.3B in benefit claims

The PhilHealth Regional Office VI said it has processed and paid P9.3 billion, or 1,197,148 of the benefit claims filed in Western Visayas, as of June 25, including P2.13 billion for 293,790 claims in Bacolod City, and P1.26 billion for 171,809 claims in Negros Occidental.

Approved for payment were 20,594, or 1.43 percent of claims, in the amount of P109,550,908.40 while 5.79 percent, or 83,140 benefit claims equivalent to P447,202,635.89, are in-process, Janimhe Jalbuna of the PhilHealth 6 Public Affairs Unit said in a statement furnished to the Daily STAR yesterday.

In Bacolod, approved for payment were 5,370 claims, worth P27,212,465, and  2,628 claims, in the amount of P15,450,853, in Negros Occidental.

In-process are 22,820 claims, worth P111,919,690.65 in Bacolod, and 10,331 claims, equivalent to P60,507,372.68 in the province, the PhilHealth statement added.

PhilHealth Regional Office VI recognizes its duty to process and reimburse claim benefits that were afforded to its members in Western Visayas, and has paid 83.48 percent of good and complete claims in an average of 27 days in 2020 to 2021, it added.

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, the PhilHealth said.

A total of 109,068 or 7.61 percent, in the amount of P689,978,723, were returned to the healthcare (RTH) institutions for compliance of requirements while 24,180 (1.69 percent) claims, worth P181,632,786, have been denied, it added.

In Bacolod, 12,820 claims worth P94,988,675 were returned, while 4,125 claims, amounting to P27,925,135 were denied. In Negros Occidental, 22,431 claims equivalent to P101,682,233.80 were categorized as RTH and 4,853 claims, worth P33,800,796, were denied, the PhilHealth data show.

Returned and denied claims that will be re-filed or appealed will undergo validation and re-processing before payment, Jalbuna said, adding that, “These are not considered arrears of the PhilHealth while not yet approved for payment.”

PhilHealth reminds healthcare institutions to promptly submit their claims in order for those to be validated and paid at the soonest possible time.

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

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