QUEZON CITY, (PIA) — An official of the Philippine Health Insurance Corp. (PhilHealth) on Tuesday outlined the benefits of the agency’s Financial Management and Reporting Enhancement Program (FinMAREP) during the 16th Kapihan sa Bagong Pilipinas media media forum at the Philippine Information Agency.
According to Dr. Bernadette C. Lico, Vice President of PhilHealth Regional Office NCR and Rizal, the FinMAREP initiative, established under Circular No. 2023-0028, focuses on “periodic reconciliation and enhanced recording of benefit claims transactions” between PhilHealth and health facilities (HFs) in the National Capital Region.
“We have developed a utility for electronic periodic reconciliation, as we have around 1,500 facilities,” Dr. Lico explained.
She emphasized that a manual reconciliation process would be impractical, so the new system allows for simultaneous electronic submissions of queries regarding the status of claims submitted to PhilHealth.
“Within ten working days, we can match these claims for reconciliation,” she added.
Lico noted that hospitals often consider their accounts receivable when dealing with claims that are returned or denied.
However, she clarified that denied claims and those returned to hospitals are not included in the accounts receivable for PhilHealth.
“With FinMAREP, we achieve a thorough reconciliation of claims, ensuring greater transparency in the accounts and books of each agency involved,” she said.
The FinMAREP initiative is also in compliance with the Philippine Accounting Standards (PAS) and the recommendation by the Commission on Audit (COA), which is an initial effort towards the realization of the automated accounting system on benfit claims and compliance with RA 11032 or the “Ease of Doing Business and Efficient Government Service Delivery Act of 2018.”
When asked about the reasons for claim denials, Lico explained that claims are often denied if the submitting facility or physician is not accredited or if the treatment provided does not meet the standard of care required for the claim.
“Through this program, we aim to enhance the efficiency and accuracy of claims processing, ultimately benefiting both healthcare providers and patients,” Lico said.
The implementation of FinMAREP is expected to foster better communication and understanding between PhilHealth and health facilities, paving the way for improved healthcare services in the region. (JLN/PIA-NCR)
