The Philippine Health Insurance Corporation (PhilHealth) Western Visayas office is set to reimburse approximately 82,353 previously denied claims due to late filing, amounting to over PHP 591.91 million, under its new flexibility in claims policy.
Under PhilHealth Circular 2025-0006, which took effect on March 21, claims submitted between January 1, 2018, and December 31, 2024, will be reconsidered. This period marks the implementation of the state health insurer’s electronic claims system.
“The purpose of this policy is for us to pay hospitals with denied claims that were denied previously because of late filing,” said PhilHealth-6 Public Affairs Unit Head Janime Jalbuna in an interview Tuesday.
Jalbuna explained that under existing regulations, healthcare facilities must file reimbursement claims within 60 days after a patient’s discharge. Claims submitted beyond this period were automatically denied.
The reconsideration will include claims reviewed by the PhilHealth Regional Office Benefit Administration Section, those under administrative protest with the PhilHealth Regional Office Claims Review Committee, and those appealed to the Protest and Appeals Review Department.
“These would even include our Z-benefit package and outpatient HIV-AIDS treatment package as long as they file the claims within the same period – January 21, 2018, to December 31, 2024. Under the policy, they can file up to six months since the circular took effect, which means they can file until September 22, 2025,” Jalbuna added.
However, claims not submitted within the prescribed period will be denied with finality.
This policy adjustment is seen as a significant relief for healthcare providers who have rendered services to PhilHealth members without receiving reimbursement due to technical filing issues.
In addition, Jalbuna announced that PhilHealth will waive the 45-day benefit limit starting April 4.
“Meaning, PhilHealth will continue to pay for the succeeding confinement if the patient has exhausted the 45 days. We no longer have a limit on the number of days in the confinement of the member and qualified dependents,” she said.
The move aims to provide better healthcare support for PhilHealth members and ease the financial burden on healthcare institutions.