SIHAY
Software Solutions

Definition: Seamlessly links the hospital’s HIS to PhilHealth’s official eClaims portal for paperless claim submission.

Uses: Speeds up processing, reduces paperwork, and ensures real-time claim transmission.

Definition: Checks a patient’s PhilHealth membership, contributions, and benefits before admission or billing.

Uses: Prevents claim denials by ensuring valid coverage before service delivery.

Definition: Monitors claim status from submission to approval or rejection.

Uses: Enables faster follow-ups, reduces delays, and improves reimbursement timelines.

Definition: Stores and organizes required PhilHealth claim documents like CF1, CF2, and medical abstracts.

Uses: Ensures completeness of claims, reduces lost files, and speeds up compliance checks.

Definition: Automatically computes case rates, professional fees, and reimbursements.

Uses: Minimizes human errors, ensures accuracy, and speeds up claim preparation.

Definition: Validates claim data and attachments against PhilHealth’s rules before submission.

Uses: Reduces rejections, ensures accurate coding, and improves claim acceptance rates.

Definition: Generates detailed claim and reimbursement performance reports.

Uses: Helps management track trends, identify bottlenecks, and improve operational efficiency.