PhilHealth reprocesses P8.8B in denied claims

PhilHealth announced on Thursday it will reprocess approximately P8.8 billion in previously denied claims involving 1.1 million cases to address a backlog caused by late hospital filings.

The new policy, which went into effect on March 21 and was published with board approval on the same day, allows hospitals six months from that date to resubmit claims covering unpaid services from January 1, 2018, to December 31, 2024.

PhilHealth spokesperson Dr. Israel Francis Pargas noted this policy covers all denied claims due to the 60-day late filing period and includes those previously returned but not refiled by hospitals.

Acting President and CEO Edwin Mercado said during his first press conference that most of the denied claims were due to administrative reasons, such as late filings, rather than fraudulent activity, aiming to enhance service efficiency and rebuild trust in the national health insurance system.

Mercado also stated that claims denied for being filed beyond 60 days account for 30% to 40% of all unpaid or denied claims, while the remaining percentage is still under review.