PhilHealth to use AI for faster claims reimbursement

MANILA, Philippines — The Philippine Health Insurance Corp. (PhilHealth) will be using artificial intelligence or AI to fast-track the processing of health insurance benefits.

PhilHealth has signed a proof of value agreement with Pulse 63 HV Philippines (SwiftClaims) for the use of a special software designed by the company to enhance the process of reimbursements.

Signatories to the agreement were PhilHealth president and cahief executive officer Emmanuel Ledesma Jr., chief information officer Jovita Aragona,  SwiftClaims CEO Louis Kweyamba Maguru and deputy managing director Arvind Appavu.

According to PhilHealth, the initiative aims to reduce claims processing time and minimize claims being returned to hospitals due to deficiencies.

The state health insurer said the AI-powered system is expected to process claims in real time, applying complex business rules and validating against PhilHealth policies.

Expected results include the elimination of manual intervention and acceleration of approval as well as payment of claims to partner health facilities, PhilHealth said.