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Written by PHU

Category: News and Events

Published: 06 March 2025

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As part of National Health Insurance Month celebration, the Billing and Claims Section in collaboration with the Public Health Unit conducted a round table discussion titled “PhilHealth Benefits: A Forum on Efficient and Effective Claims Processing and Availment” on February 28, 2025 at Pag-Asa Hall. This aimed to raise awareness on PhilHealth benefits and deepen participants’ knowledge and understanding on health insurance processes. Moreover, this served as a platform to inform and educate concerned participants on the most efficient ways to navigate claims processing while ensuring adherence to PhilHealth circulars and policies.

Officials from PhilHealth Regional Office (PRO) – NCR North spearheaded the discussion on various PhilHealth transactions including significant processes and guidelines. Ms. Geraldine T. Infantado, Benefits Administration Section (BAS) Information Officer and Adjudication Team Leader covered the topics on proper labeling of PhilHealth documents, implementation of Electronic Statement of Account (e-SOA), Top Reasons for Return to Hospital (RTH) and Denied claims and other related policy reminders. Furthermore, Dr. Jose Miguel C. Albornoz, Medical Specialist III of BAS Medical Unit highlighted the new PhilHealth circulars, its scope, policy statements and guidelines, both for inpatient and outpatient benefits. Likewise, attendees had the opportunity to address and clarify their concerns and queries related to different circulars and policy changes.

The activity underscores the importance of compliance with all relevant requirements and policies, aiming to create more efficient health insurance processes and improving the quality of claims processing and availment.