PhilHealth to process P8.8 billion in denied claims

MANILA, Philippines — The Philippine Health Insurance Corp. will reimburse P8.8 billion worth of hospital claims that were previously denied due to late filing — a decision that stands to benefit approximately 1.1 million claims submitted between 2018 and 2024.

The decision comes after the PhilHealth board approved a new policy specifically addressing claims rejected for exceeding the 60-day filing period.

PhilHealth began using an electronic claims filing system in 2018 that automatically denied submissions made after the deadline.

"We will process these claims so that the hospitals that provided service to the public will be compensated," PhilHealth President Edwin Mercado said at his first press briefing as the head of the state insurer on Thursday, March 6.

The policy officially takes effect on March 21. After this, public and private health facilities are given six months to file claims previously denied due to late submissions, according to the state insurer. Claims that are "unprotected" and "unappealed" from 2018 to 2024 will be considered for reprocessing.

Additionally, denied claims currently pending in court could also be reconsidered if appellants withdraw their litigation against the corporation.

At least 30% to 40% of all denied hospital claims are due to late filing, Mercado said.