Philhealth e-claims provides efficient service to patients-A A +A
Friday, October 11, 2013
THE Philippine Health Insurance Corp. (PhilHealth) electronic claims (e-claims) that have been integrated in hospital information system (HIS) will ease PhilHealth processing in hospitals, resulting in a more efficient and faster service for patients, an official said.
Segworks Technologies Corp. senior vice president for Administration and Finance Fred Nadela said that Segworks, being one of the few health information technology providers accredited by Philhealth for e-claims, has integrated the electronic system to be embedded to HIS, a system wherein the hospital inputs the data of the patients and can be viewed by doctors and nurses.
Orders on medications and treatment procedures can also be viewed through HIS.
"By embedding e-claims in an integrated HIS, one can access all the data needed to be submitted to PhilHealth. There is no need to re-encode data for PhilHealth, which results to a more efficient and faster processing," Nadela said in his presentation at the Innovation Expo 2013 iForum held at Seda Hotel on Friday.
He explained the step-by-step procedure on how the embedded e-claims will fall in place.
He said that during the admission phase, any information taken from the patient will be encoded into the HIS.
During confinement, medicines, treatment, and procedures the patient has to undergo will be added to the patient's data. The same goes into the billing phase wherein the payment details will be included in the data and finally, the discharge of the patient.
Through the embedded e-claims, PhilHealth will be able to verify if the patient is already a member or not in the admission phase. In the billing phase, a member may electronically claim his or her needed support and benefits.
Nadela said the embedded e-claims will allow faster process in the hospital, which translates to faster release of claims, better cash flow, and increase in revenue.
The single encoding process means more accurate claims, he said, adding that the integrated system will also reduce manpower needed to process claims, which means less operational expenses.
As for the members of PhilHealth, the new innovation will mean no long queues, less documents, and less fraud.
The PhilHealth e-claims module allows its member verify if his or her membership, and if he or she qualifies for the support, submit claims electronically, and the hospitals can track the claims online.
Nadela said when fully implemented, the system will give hospitals and patients paperless convenience, instant response, less people to process the claims, and expedited payment.
Some 1,700 hospitals nationwide are using e-claims, with an estimated market of P300 million annually.
Segworks is targeting to serve 100 more hospitals.
Published in the Sun.Star Davao newspaper on October 12, 2013.