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PhilHealth denies P134M unpaid claims

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The Philippine Health Insurance Corporation (PhilHealth) denied that it owes Corazon Locsin Montelibano Memorial Regional Hospital P134.6 million of unpaid claims.

In her letter to Bacolod Rep. Greg Gasataya dated August 3, PhilHealth regional vice president Valerie Anne Hollero requested that she be enlightened as to the source of the claims their office supposedly owe CLMMRH since there is nothing in their data that would support it.

Earlier, Gasataya requested PhilHealth president and chief executive officer Ricardo Morales to settle the receivable claims of CLMMRH amounting to P134.6 million, as of June 30.

Hollero said PhilHealth Region VI is fully aware of the importance of financial security and liquidity of health care institutions (HCI) especially at this time of pandemic.


She said the PhilHealth national office has exerted efforts to make sure that claims of the HCIs in the region are substantially and promptly paid. The average turnaround time (TAT) of PhilHealth for payment of claims has also greatly improved, Hollero said.

For CLMMRH, the TAT for payment is 34 to 42 days upon receipt of the claim, while average TAT of CLMMRH is 59 days from date of discharge of the patient to the time claim was filed, she said.

As of July, the total paid claims by PhilHealth for year 2020 to CLMMRH was P247,869,270.29, Hollero said.

She added that claims approved for payment and in-process, which are considered as CLMMRH receivables from PhilHealth, amounts to P21,829,936.

Hollero said the CLMMRH probably refers to the Returned to Hospital (RTH) claims from 2018 to 2020. A total of 22,089 claims returned to CLMMRH amounted to P306,468,442.29.

Of these, only 3,451, amounting to P46,609,364.29 have been re-filed by CLMMRH.

To date, there are still 18,638 claims in the amount of P259,859,078, Hollero said.

Claims should be refilled within 60 days upon its receipt to avoid their denial, she added.


Hollero said the top three claims of CLMMRH from 2018 to 2020 are: pneumonia high risk (3,578 claims) in the amount of P119,277,640, caesarian section (3,778 claims) – P75,212,600, and pneumonia moderate risk (4,943 claims) – P74,469,780. Since pneumonia is the most abused case rate, medical evaluation is done before these case rates are paid.

CLMMRH is also the only hospital in Region VI that submits its claims manually, resulting to longer turnaround time for payment of their claims, Hollero said as PhilHealth has repeatedly encouraged the hospital to shift to eClaims.*


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July 2024

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