Philippines Launches First Electronic Claims System

Medilink recently launched its computerized claims clearing house network
system for hospitals, HMOs, health insurers, self-insured corporations,
clinics, and independent physicians associations. It is the first to
provide electronic eligibility, electronic claims processing, and
electronic funds transfer in the Philippines.

Presently, clients submit piles of paper to their HMOs or insurance
companies if they want to to claim their benefits or services.

With Medilink, each member of a health plan will be issued a Medilink smart
card. Each time a member visits an affiliated hospital or clinic, the card
will be swiped through a terminal connected to the central computer of
Medilink for verification of membership and health plan benefits. A print
out of the benefits of the member will be issued from the terminals printer.

Upon discharge from a hospital, the health card will again be swiped and
the charges entered on the terminal. A printout of the accepted charges
will be printed in the terminals printer. All before the patient
effectively checks out.

If the claim is within the plans specifications, it is cleared for payment.
Upon instructions from the customer, Medilink electronically
finalizes electronic bank transfer from the payer’s account to the
provider’s bank account.

The growing concern for quality and and efficient healthcare services
mainly among corporate employees has resulted in the proliferation of HMOs
in the country.

After an aggressive, rate-cutting expansion phase, several HMO’s owned and
operated by doctors are now facing a phase of consolidation because of
natural inefficiencies and human limitations in their administrative
systems, according to market sources.

Around 2 to 2.5 million Filipinos are presently covered by HMOs and
Non-Life Insurance companies with health plans. The country at the moment
has around 40 HMOs. This number is expected to double in a couple of years.
The business volume of the HMO sector reaches 2 billion pesos per annum.

While the hospital sector is highly interested in prompt payments, the HMO
sector is seriously challenged to improve eligibility and
claims efficiency, according to a survey conducted by Medilink.

“We can guarantee that the system we built is very reliable,” said Deither
Bruckner, general manager of AIZ Information Services. “We’re using the
Equitable Card Network infrastructure to facilitate the electronic transfer
of electronic documents to electronic payment in this system.”

Medilink implemented the first of its three business phases; an eligibility
phase started in March 1999 where they have signed up several major HMOs
which will process part or all of their members at selected hospital
coordinators in Metro Manila.

The first phase in Manila will be finalized by May 1999 and its Roll out to
key provincial areas will follow.

The eligibility phase is the groundwork for the claims processing. Data
downloaded on to the Medilink server from the Managed Care companies is
required for the future claims processing services.

The second and third phases implementing the Electronic claims processing
and electronic fund transfer are scheduled for May/June 1999.

A Medilink service providing emergency data will be available second half
of 1999. The structure of this data complies with the G7
and the European community agreement.

The Emergency Data Service will, according to sources, be designed to
process medical information quickly during emergency cases when a patient
is unconscious.

“We’re still finalizing the details of this service and how we’ll be
introducing this to the market,” said Bruckner.

Managed care organizations, insurance companies with Health plans, IPAs and
self-insured corporations may subscribe to Medilink
electronic claims clearinghouse services as payer subscribers.
Hospitals, clinics, independent physicians may join the Medilink service as
service provider subscriber.

Medilink expects to process around 80% of the submitted in-patient claims
by the service providers to be processed electronically
without human intervention of any kind. The rest of the in-patient claims
will still need human intervention for authorization and

At this moment, eligibility of members for medical services from several
HMOs namely, MaxiCare and MediCard, are verified utilizing Medilink
terminals fielded at Makati Medical Center, St. Luke’s Medical Center in
Quezon City, Medical City General Hospital and Health Solutions in
Mandaluyong City.

“Also, we’re going to provide outpatient claim services as well,” said
Bruckner.”We are now training MaxiCare Hospital Liason Officers
in Quezon City on how to use the Medilink system. This will be rolled out
next week initially with hospitals like St. Luke Medical Center, Polymedic
Hospital , Metropolitan Hospital, and Manila Doctors Hospital.

Medilink, is a cooperative effort between AIZ, a company of the Zuellig
Group, and the Equitable Card Network. The joint venture was supported by
SGV Arthur Andersen as its system integrator.

News Around the Web