PhilHealth to process P8.8 billion in denied hospital claims from 2018 to 2024

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This involves 1.1 million claims filed by hospitals from January 2018 to December 2024

MANILA, Philippines – The Philippine Health Insurance Corporation (PhilHealth) will work on processing P8.8 billion in denied claims of its member-hospitals in the coming months.

This involves 1.1 million claims filed by hospitals from January 2018 to December 2024. According to PhilHealth, 30% of these were denied due to late filing.

“Marami sa mga sinumiteng claims na ito ay denied dahil lagpas na sa deadline o iba pang mga administrative reasons at hindi naman dahil sila ay fraudulent. Ang mga ito ay muling ipo-proseso upang ang mga ospital na naghatid ng serbisyong kinakailangan ng ating mamamayan ay mabayaran,” PhilHeath President and Chief Executive Officer Edwin Mercado said on Thursday, March 6.

(Most of the submitted claims were denied because they were either sent past the deadline or they had other administrative reasons but they are not fraudulent. These will be reprocessed so that hospitals that have rendered services needed by our people will be paid back.)

This is among the first commitments made by the newly-appointed Mercado, who is working on making the state insurer’s processes more efficient.

Mercado took the post of Manuel Ledesma Jr. on February 4, the first day of the oral arguments on PhilHealth’s P89.9 billion fund transfer. He told reporters on Thursday that among the first things he did with the state insurer is to work on regaining the trust of its stakeholders.

Under this new flexibility claim reimbursement policy, hospitals will be given six months to fix their documents and submit claims that were previously denied due to late filing.

According to PhilHealth, claims filed from January 1, 2018 to December 31, 2024 labeled “unprotested” and “unappealed” will be considered. – Rappler.com