PhilHealth-7 holds retooling to boost claims processing
CEBU, Philippines — PhilHealth Regional Office VII, through its Health Care Delivery Management Division, recently held a two-day retooling activity titled “ReachOut Forward: Strengthening Our Partners in Health.”
The event gathered Level 1, 2, and 3 hospitals from Cebu, Bohol, Negros Oriental, and Siquijor.
According to PhilHealth-7, the initiative aims to enhance claims processing and reduce Return-to-Hospital (RTH) and denied claims, underscoring the agency’s commitment to equipping healthcare providers with strategies and best practices that improve claims efficiency, strengthen payment systems, and ensure timely benefit delivery to members.
The sessions included updates on medical prepayment review, rationalized case rates, outpatient and emergency care guidelines, accreditation requirements, the No Balance Billing policy, claims filing reminders, and Benefit Payment Notice (BPN) updates. Subject matter experts facilitated discussions, offering participants practical guidance for implementation.
The first day focused on hospitals in Cebu, while the second day covered healthcare providers and hospital representatives from Bohol, Negros Oriental, and Siquijor.
The activity highlighted the region’s unified approach to implementing key policy reforms, introducing new benefit packages, and improving claims processing efficiency.
Key discussions centered on the PhilHealth Outpatient Emergency Care Benefit (OECB) package and the Medical Prepayment Review process for frequently submitted claims such as pneumonia, urinary tract infection, sepsis, and acute gastroenteritis. These aim to ensure faster and more accurate claim payments across participating provinces.
The activity reinforced PhilHealth’s commitment to equipping its partners with the knowledge and tools needed to implement the latest policies, ensuring accessible and quality healthcare services for all members across Central Visayas.
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