Philhealth 12 ensures strict medical evaluation of Covid-19 claims before payment

Newly installed  Philhealth XII  Acting Regional Vice President Dr. Hector Zenon Leonardo P. Malate disclosed that all claims related to the Covid-19 pandemic pass through a strict medical evaluation to ensure that payment due to the healthcare provider is true.

During the “Kapihan sa Kapitolyo”  held at the Provincial Capitol compound in Koronadal City, AVP  Malate said, the process actually is quite slow but at least this will make all things right in the payment of their claims.

Earlier, Malate issued an advisory to all accredited Health Care Institutions (HCIs) in the region to submit certified true copies of  COVID claims clinical charts.

Section V of Philhealth Circular No. 2019-002 provides that the corporation reserves that right to subject all claims to medical prepayment review; and to request the true copies of the complete clinical charts when additional information is necessary.

“This is to ensure accountability and extensive checking of claims involving high cases rate packages.” He said,

As of November 30, 2020, Phileahlth 12 received at least 794 Covid-19 claims.

But out of these claims, only four (4) were paid amounting to Php158,273.49 only.

For the rest of the claims, 580 are still in the process; 20 were denied, and 190 are Return to Hospitals (RTH).

Based on the report from  SOCCSKSARGEN Region Covid-19 tracker as of  December 15, there are already 4,277 confirmed cases in Region 12.

In South Cotabato, there are already 1063 cases; 1251 cases in general Santos City; 1006 in Cotabato City; 391 in Sarangani; 235 in Sultan Kudarat, and 331 in North Cotabato.

Malate shares that he is also in favor that benefit packages for covid-a9 be lowered so that funds will not be easily depleted.

“This is still under review and hopefully be implemented next year.  he said,