Automated health insurance claims eyed mid-2018

TACLOBAN CITY, Feb. 6  -- State-run Philippine Health Insurance Corporation (PhilHealth) is eyeing to automate transaction of all hospitals in Eastern Visayas by mid-2018 to improve operational efficiency in the processing and payment of claims.

PhilHealth Regional Vice President Renato Limsiaco said automation would reduce turnaround time to 15 days from 42 days under the manual system.

“The target is to automate the system by March 2018. If it’s not attainable, we can extend the deadline until June provided that we look (at) the action plan of hospitals,” Limsiaco said on Tuesday.

Under the automated system, encoded claims information in the hospital systems can now be submitted online via the PhilHealth web service, which will eventually provide hospitals and other institutional health care providers to view status of their claims online.

“We don’t have to rely on our current speed as we want to make sure that claim submission is fast, immediate release payment to the facility to finance better healthcare service,” Limsiaco added.

Aside from faster release of claims to hospitals, the system also seeks to come up with database of the most common health problems of patients admitted in hospitals.

“Through electronic claims, the Department of Health will be able to see the health situation in the region because we have the data readily available in the system. This will guide our health workers in the planning stage,” the official said.

Last week, the government health insurance firm certified the software that had been used by the Leyte provincial government in the processing of claims.

This was the first PhilHealth-accredited software managed by a local government, said Limsiaco.

Leyte Governor Leopoldo Dominico Petilla said the system, which had been running for several years, covered hospitals supervised by the provincial government.

“They want the system to be replicated in other provinces in the country. What PhilHealth is requesting is to include rural health units in Leyte. We are optimistic to expand this in our province with the support of computer programmers who are scholars of the local government,” said Petilla.

In 2017, PhilHealth paid PHP3.6 billion claims to hospitals in the region with 82 percent processed through automated systems. (SQM/PNA)