PhilHealth soon to make e-transactions mandatory for hospitals



The Philippine Health Insurance Corporation (PhilHealth) is set to make electronic transactions mandatory for hospitals that have the capability of connecting through the Internet.

This was revealed by PhilHealth President and CEO Dr. Eduardo P. Banzon during his visit to Davao City last Saturday.

“Davao City is well-connected so there is no excuse for hospitals to not be connect
ed once we make electronic transactions mandatory for them,” Banzon said. He said the same case is true for Tagum City which seems to be also well-connected electronically.


Banzon said PhilHealth’s direction is towards the interconnection of PhilHealth with hospitals all over the country through electronic transactions, to make the transactions more efficient. He said PhilHealth is set to implement its automation program as part of its goal to provide improved services to its members.

One component of PhilHealth’s automation program is the e-claim project which will allow accredited hospitals to have access to the database of PhilHealth for purposes of
verifying the members’ eligibility. The ultimate goal, Banzon said, is to make the whole process efficient for its members.

Banzon cited the new case rate
payment method, which was implemented September last year, as a better way that allows PhilHea
lth members to determine the exact amount of their coverage for eleven most common medical cases like Pneumonia and Hypertension, and 12 surgical cases.

“Case rate is more beneficial both to PhilHealth members as it is more transparent, and to health care providers as it is simpler to administer,” he said. The illnesses and surgical cases covered under the case rate payment scheme are based on the cases which PhilHealth paid in the past years.

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