AS AN OFFSHOOT of its consultations with stakeholders from the health care providers sector, the Philippine Health Insurance Corporation (PhilHealth) recently introduced the Reconciliation Summary Module (RSM) in its Health Care Institution Portal to provide its partner hospitals with updates on the status of claims reimbursements.
The RSM aims to provide hospitals with complete and timely information on the progress of their claims submitted to the state health insurer, particularly on claims received, in process, already paid, or denied. They can also cross-reference their claims data against PhilHealth records with precision, eliminating inaccuracies caused by errors such as double-entries. Additionally, the users can also check if a claim is due to be returned and the possible remedies to ensure reimbursement.
With the said module, hospitals will no longer receive the Summary Status Reports as contained in a previous PhilHealth Advisory No. 2018-0042. Hospitals can access updated status reports from the RSM anytime by just logging in to their respective HCI Portal accounts.
A user manual is also made available in the portal to assist them in making full use of the RSM.
On the other hand, hospitals without existing accounts in the HCI Portal can obtain access to the online facility by submitting a properly accomplished PhilHealth Online Access Form and Non-Disclosure Agreement to the nearest PhilHealth Regional Office (PRO).
Should there be discrepancies in records, hospitals are advised to immediately contact the PRO in their area to discuss and resolve said concerns together.
For more details and for suggestions and feedback, hospitals may call PhilHealth’s 24/7 Corporate Action Center hotline (02) 441-7442 or send e-mail queries at firstname.lastname@example.org. (END) (JJ Rico)
Reference: Corporate Affairs Group | Trunkline: 441-7444 loc. 7652 & 7653