PhilHealth simplifies reimbursement claims for healthcare providers
Tuguegarao City (7 January) -- With the new reimbursement scheme that took effect recently, HEALTH care providers accredited by the Philippine Health Insurance Corporation (PhilHealth) need not wait for several months before receiving their refunds.
Dr. Rey Aquino, PhilHealth President and CEO, in introducing the Simplified Reimbursement Scheme (SRS) said that its primary objective is to provide for faster and more efficient reimbursement process to boost PhilHealth's partnership with its health care providers.
Under the SRS, provider claims of eligible members shall be paid 75 percent of the amount being claimed and the remaining 25 percent shall be paid subject to review of the submitted documents.
The PhilHealth Chief said they need to ascertain the completeness of the documents submitted, and check on the member's eligibility for availment, but eligible claims of accredited providers shall be processed and paid within 30 days from receipt.
Oscar Abadu, Jr., PhilHealth Region 2 Officer-in-Charge emphasized that the SRS will not be applied to claims for professional fees of accredited physicians, case payments and directly-filed member's claims.
Health care providers are required to comply with existing PhilHealth policies, and adherence to applicable laws and clinical standards of practice shall also be monitored and any deviations or violations on existing policies and guidelines shall be excluded from the scheme without prejudice to other appropriate actions the Corporation may undertake. (PhilHealth/PIA 2) [top]