Reconcile data on claims, PhilHealth, hospital told

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BY CHRYSEE G. SAMILLANO

Bacolod Rep. Greg Gasataya said he hopes that the Philippine Health Insurance Corporation (PhilHealth) and Corazon Locsin Montelibano Memorial Regional Hospital (CLMMRH) will be able to reconcile their data concerning the hospital’s claims receivable from PhilHealth amounting to P134.6 million, as of June 30.

Gasataya said that upon receipt of PhilHealth’s reply, his office endorsed the matter to CLMMRH medical chief Dr. Julius Drilon for verification of the figures on the total amount of claims that it owes to the hospital.

“It is clear from the letter of PhilHealth that while it categorically denied that it owes CLMMRH the amount of P134.6 million, there are claims of CLMMRH that are yet to be settled,” Gasataya said.

The solon said the letter also mentions the return to hospital (RTH) claims amounting to P259,859,078.

“It is crystal clear that, while the figures may vary, PhilHealth owes CLMMRH,” Gasataya said.

“In our letter addressed to PhilHealth president and CEO, Ricardo Morales, last July 27, we made it clear that it was Dr. Drilon who provided the information in our letter, as well as the attached breakdown of CLMMRH’s claims ending June 30 for their collectibles,” he added.

With these, they are hoping that both parties will be able to reconcile their respective data so as not to put the people of Bacolod and Negros Occidental at the losing end if the matter remains unresolved, he said.

In her letter to Gasataya dated August 3, PhilHealth regional vice president Valerie Anne Hollero said PhilHealth is exerting effort to make sure that claims of the HCIs in the region are substantially and promptly paid.

For CLMMRH, the TAT for payment is 34 to 42 days upon receipt of the claim, while average TAT of CLMMRH is 59 days from date of discharge of the patient to the time claim was filed, she said.

Total claims paid by PhilHealth for year 2020 to CLMMRH as of July is P247,869,270.29, Hollero said, admitting that there are still 18,638 claims amounting to P259,859,078.

Claims should be refiled within 60 days upon its receipt to avoid their denial, she added.*

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