CALAPAN CITY, Oriental Mindoro (PIA) — The Philippine Health Insurance Corporation (PhilHealth) in Oriental Mindoro granted an extension for all accredited Konsulta providers in the province to ensure all their 2024 data is uploaded and forwarded to PhilHealth to resolve data issues.
Oriental Mindoro Chief Social Insurance Officer Ma. Neresa C. Reganit said that many accredited Konsulta providers have successfully renewed their accreditation with the health insurance body. However, issues with data transmission are preventing the processing of payments.
“Ngayon po ang ating mga Konsulta providers ay nag-renew talaga ng kanilang accreditation sa PhilHealth bilang Konsulta providers natin. Ang nangyayari kung bakit hindi pa bayad ay hindi pa nakakatawid sa PhilHealth ang maraming data…hindi pa nila naipapasok sa system kaya hindi pa nakakatawid sa PhilHealth para mabayaran,” Reganit said.
Reganit explained that the delay in payments is due to the failure of some providers to upload the patient’s data into the PhilHealth system. Although many consultations have already taken place, the necessary data have not been processed, preventing the creation of accounts payable for these services.
While PhilHealth used to generate monthly statements of accounts for payment, the system currently cannot process these transactions due to missing data. In some cases, problems stemmed from technical glitches or staff resignations, resulting in a backlog of data entry. PhilHealth representatives have been visiting facilities to address the issue, Reganit explained.
“In 2024, monthly po tayo nag gegenerate ng statement of accounts payable para mabayaran, kaya lang sa aming assessment, kapag tinitignan namin ay wala pong tumatawid na data. That is why we go to their place, we go to their facilities and ask them kung bakit hindi nakakatawid ang data and sometimes may problema sa system or nag resign yung encoder nila, so yung data na dapat ay nandyan at nabayaran ng PhilHealth ay hindi naipapasok,” she said.
Despite these hurdles, Reganit assured all accredited Konsulta providers that they can still upload their data until March 31, 2025.
“We’ve granted an extension for the 2024 data encoding process. Providers now have until March 31, 2025, to ensure that all their data are uploaded.” she said.
Meanwhile, PhilHealth encourages patients to avail of Konsulta benefits as the agency works toward resolving the data issues.
PhilHealth’s Konsultasyong Sulit Tama (Konsulta) is a comprehensive outpatient benefits as mandated by the Universal Health Care Law. Under this program, all Filipinos shall be registered with an accredited PhilHealth Konsulta provider of their choice and be eligible to avail of condultation, health risk screening and assessment, selected laboratory and diganostic test, and selected drugs and medicine. (AS/PIA MIMAROPA-Oriental Mindoro)
