Billing/Claims Processes

1. Daily hospital charges and billings, as much as possible, are to be monitored and communicated to MEDI-access Operations via electronic billing or through phone. This is done to facilitate the process of claims adjudication and payment of eligible charges. The earlier the bills are reconciled, the faster the payment occurs.

2. In the absence of electronic (internet) billing upon discharge of the MEDI-access patient, the hospital charges are to be compiled and completed by the hospital Billing Department.

3. The hospital Billing Department would now arrange for the delivery or pick-up by MEDI-access of the completed billings for the discharged MEDI-access patient. MEDI-access assures expeditious payment of the bills based on totality of the documents and properly adjudicated claims and charges. MEDI-access requires the following:

a. Filling up of the Billing Cover Sheet (to be provided by MEDI-access). This is to be attached to the hospital records and charges. This cover sheet may be faxed to MEDI-access to facilitate early processing of the claim.

b. Charges and billings to MEDI-access must reflect amounts less Ineligible Charges based on the benefit limits of the patient/client as stated in the Letter of Authorization (LOA). The patient/client understands that ineligible charges are to be settled personally with the hospital prior to or upon discharge.

c. Charges and billings to MEDI-access must reflect amounts less Philhealth and/or other co-insurance.

d. Promptness of notification of the hospitalization and discharge. This is to allow MEDI-access to expedite early settlement of the hospital bills/charges.

4. MEDI-access will expeditiously process the payment of the hospital claim UPON receipt of the Cover Sheet and/or hospital records and billings. The payment process are as follows:

a. Upon receipt of the clean claim (all documents are complete), MEDI-access will adjudicate for completion, eligible charges and covered benefits. Deficient claims will be returned for completion and corrective measures.

b. Within 24 hrs upon receipt, the adjudicated claim will be forwarded to the Healthway Finance Department with the payment/check production request.

c. The Healthway Finance Department guarantees a maximum of five (5) working days for payment checks to be mailed out.

d. Electronic billing and payments can also be arranged with MEDI-access and the Healthway Finance Department.

5. Contact Person: Mr. Jayjay Tolentino – Claims and Billing Supervisor

Mobile number: (+63917) 807-7469

Telephone No: (632) 381-0063

Telefax No : (632) 751-4958