ARTA asks PhilHealth to simplify medical pre-payment review

ARTA asks PhilHealth to simplify medical pre-payment review

MANILA – Amid backlogs on the release of payments for claims of hospitals, the Anti-Red Tape Authority (ARTA) has recommended to the Philippine Health Insurance Corp. (PhilHealth) to simplify its medical pre-payment review.

In an interview with ABS-CBN News Channel on Friday, ARTA Director General Jeremiah Belgica said PhilHealth’s medical pre-payment review is the main cause of delayed payments to hospitals.

The agency has recommended to PhilHealth to require only two ministerial documentary submissions and do the medical review of the diagnosis post-audit, the ARTA chief added.

Belgica said PhilHealth can do the medical review after the initial payment.

He added that the debit-credit payment method should be applied across the country, and not only in regions that are under enhanced community quarantine or modified ECQ.

“As to the PhilHealth, it’s been an interesting agency right now. It has been through a lot of stress and criticism primarily since last year. We could remember they were under the microscope because of some questionable disbursement they did, and now it appears that they are very, very careful at the same time to a fault already because the releases are taking time,” Belgica said.

The ARTA chief said PhilHealth’s regional offices should adhere to the 60-day period of payment disbursement, which is stated in PhilHealth’s charter.

Aside from the medical pre-payment review, the state insurer’s information and communications technology (ICT) system also causes payment backlogs to hospitals.

Belgica said a task force was also created to help in addressing concerns related to PhilHealth.

The task force is composed of ARTA, PhilHealth, Presidential Adviser on Streamlining of Government Processes, the Department of Health, Food and Drugs Administration, Health Technology Assessment Council, Department of ICT, and the Commission of Audit.

“We are willing to help them in the streamlining. But we warn them, abide by the 60-day period, otherwise, they could be investigated by ARTA,” Belgica said. (PNA)

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