PhilHealth

PhilHealth-NCR completes first-ever claims reconciliation with LPGHTC 08-21-2024

August 21, 2024 — The PhilHealth Regional Office of National Capital Region and Rizal (PRO NCR) has issued a Certification for eClaims Periodic Reconciliation to the Las Piñas General Hospital and Trauma Center (LPGHTC) after completing their claims reconciliation efforts. This, after the State Agency confirmed that claims submitted by LPGHTC from January to May 2024 have been settled.

The initiative which was spearheaded by PRO NCR PFinMaREP Committee and Benefit Accounts Management and Reconciliation Team marked a major milestone in improving claims processing through close coordination with partner healthcare facilities. This is in consonance with PhilHealth Circular No. 2023-0028 on the Periodic Reconciliation and Enhanced Recording of Benefit Claims Transactions between PhilHealth and Health Facilities (HFs) which institutionalized the PhilHealth Financial Management and Reporting Enhancement Program or PFinMaREP. This groundbreaking innovation aims to hasten claims processing by providing fast and reliable service and open lines of communication with health facilities to immediately address concerns on benefit claim transactions while ensuring compliance with the Ease of Doing Business Law.

PFinMaREP proved effective in ensuring accuracy and timeliness of digital claims submissions through the Electronic Periodic Reconciliation which involves a thorough review of the Summary Report of Unpaid Claims – Accounts Receivable. Both institutions were able to cross-check, verify submitted claims, and match account receivables with account payables to address any discrepancy.

The ceremonial signing of the first-ever claims reconciliation certification was held at the PRO NCR office at the Panorama TechnoCenter Bldg. and was led PRO NCR Vice President Dr. Bernadette C. Lico, Management Services Division Head Maricel J. Maglalang, and Head of Local Health Insurance Office – Makati Rey Sulit. Meanwhile, the LPGHTC was represented by Medical Center Chief Dr. Ignacia G. Fajardo, Finance Management Officer Charlito M. Yu Jr., and Head of Claims Section Wilma Lyn E. Estigoy. ###