MANILA – The Philippine Health Insurance Corp. (PhilHealth) announced Thursday that it will begin reprocessing 1.1 million denied claims, amounting to PHP8.8 billion. This initiative, detailed by PhilHealth President and CEO Edwin Mercado during a press conference in Pasig City, is set to cover unpaid claims dating from December 1, 2018, to December 31, 2024.
Mercado emphasized that the reprocessing would incorporate a substantial portion of previously denied claims, stating that “30 to 40 percent of all denied claims with finality will be paid under the flexibility program.” He noted that the remaining 60 percent of claims are still under review, with the focus initially directed toward those with clearer reasons for denial to expedite processing.
The claims in question encompass various categories, including those returned to hospitals due to incomplete documentation, anticipated claims from patients still hospitalized, and claims currently undergoing validity assessments. By addressing these issues, PhilHealth aims to ensure that healthcare providers are appropriately compensated for their services, ultimately enhancing access to healthcare for Filipinos.
Mercado also highlighted the importance of improving bureaucratic processes within PhilHealth, stating that the program is designed to streamline operations for both hospitals and patients. “We’re still studying the 60 percent,” he explained, indicating a commitment to refining the claims process further.
Hospitals and health facilities will have a six-month window from the issuance of the circular to submit their denied claims for reconsideration. Only claims submitted between January 1, 2018, and December 31, 2024, that have not been previously appealed or contested will be eligible for reprocessing. This includes claims managed by PhilHealth Regional Office Benefit Administration Sections and those under administrative protest.
In closing, Mercado urged hospitals to prioritize the submission of their claims to facilitate timely payments, reinforcing the collaborative effort between PhilHealth and healthcare providers to enhance the overall health system in the Philippines.
