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PhilHealth and PHAPI Resolve Issues Over Unpaid Claims May 28, 2018

In a joint statement, the state health insurer and PHAPI laid out concrete steps to settle the unpaid claims filed by a number of private hospitals in some regions, among them the reconciliation of claims data to determine those that have already been paid, returned for compliance, in process, and claims that have been denied.

The PHAPI also acknowledged during a meeting prior to the signing of the joint statement that fraudulent claims do not have a place in the agreement.

“Iyong mga data na talaga namang hindi dapat bayaran at (may) fraud, I will not tolerate it also because they [PhilHealth] also have the mandate from the law that they should not pay fraudulent claims. Sometimes, meron ding mga hospitals or doctors na nagte-take advantage sa mga babayaran na claims,” Jimenez clarified.

To ensure that the issue is resolved soon, the parties also agreed to meet weekly to keep tabs on reconciliation activities on the ground and to root out other concerns toward the elimination of backlogs claims.

PhilHealth will also launch a portal to constantly apprise hospitals of their claims profile to help avoid such issues from recurring in the future. (END) (JJ Rico; Photos by Jose Mari G. San Vicente)

Reference: Dr. Israel Francis A. Pargas, Head Executive Assistant and Concurrent OIC-SVP, Health Finance Policy Sector (Mobile: 0917-8089399)

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PhilHealth and PHAPI Resolve Issues Over Unpaid Claims