AROUND 1.1 million hospital claims that have been denied by the Philippine Health Insurance Corporation (PhilHealth) for being filed late will be “reprocessed” by the state insurer.
PhilHealth president and chief executive officer Dr. Edwin Mercado, in a press briefing yesterday, said the reprocessing of the hospital claims will be done “under the flexibility claim reimbursement so that the hospitals that provided services to the people will get paid.”
“We will reimburse these claims amounting to over P8 billion for the 1.1 million claims. We will begin after 15 days from today,” he added.
The new PhilHealth chief said the claims to be covered are those filed within the period of Jan. 1, 2018 to Dec. 31, 2024.
“They were unprotested and un-appealed and the health facilities are still in the possession of those that will be considered for re-processing,” said Mercado.
He said these are claims that have been denied “only due to delayed filing, and were found as not fraudulent claims.”
Mercado said the move seeks to improve healthcare access as well as reduce bureaucratic obstacles for patients and healthcare providers.
“This can potentially provide the much-needed financial relief to the affected providers and patients, who have been waiting for claim resolutions,” he said.
PhilHealth said all concerned health facilities are given a six-month period to submit their previously denied claims due to late filing.
“Immediately, once we process them, they will be released to our regional offices for the appropriate payments to be made,” said Mercado.
