Manila: The Philippine Health Insurance Corporation (PhilHealth) Western Visayas office is set to reimburse approximately 82,353 claims that were previously denied due to late filing, amounting to over PHP591.91 million, under its flexibility in claims policy.
According to Philippines News Agency, PhilHealth Circular 2025-0006, which became effective on March 21, allows for the reimbursement of claims submitted between January 1, 2018, and December 31, 2024. This period corresponds to the inception of the state health insurer's electronic claims system. Janime Jalbuna, head of the PhilHealth-6 public affairs unit, explained in an interview that the policy aims to compensate hospitals for claims denied due to late filing.
By law, healthcare facilities are required to file reimbursement claims within 60 days after a patient's discharge. Claims submitted beyond this period are automatically denied by the system. The reconsideration process will include claims from the PhilHealth Regional Office Benefit Administration Section, those under administrative protest in the PhilHealth Regional Office-Claims Review Committee, or those appealed in the Protest and Appeals Review Department.
Jalbuna highlighted that the policy covers the Z-benefit package and outpatient HIV-AIDS treatment package, provided claims are filed within the specified period from January 21, 2018, to December 31, 2024. Claims can be filed up to six months after the circular took effect, allowing submissions until September 22, 2025. Claims submitted beyond the prescribed period will be denied with finality.
This policy shift is expected to benefit healthcare providers who have delivered services to PhilHealth members. Additionally, PhilHealth will waive the 45-day benefit limit starting April 4, enabling continuous payment for confinement beyond the initial 45 days for members and their qualified dependents, without a cap on the number of confinement days.
