PhilHealth to settle 8.8B pesos in denied claims under new policy

The Philippine Health Insurance Corporation (PhilHealth) will begin processing and settling P8.8 billion worth of previously denied claims following the release of its Flexibility Claim Reimbursement policy.

Acting President and CEO Edwin Mercado announced that the agency will process claims within 15 days of submission. The backlog consists of 1.1 million claims denied due to late filing between January 1, 2018, and December 31, 2024, provided they were not fraudulent and had no other grounds for denial.

Under the said new policy, health facilities have six months to resubmit the claims for reimbursement.

Additionally, claims eligible for reprocessing include those currently held by PhilHealth Regional Office Benefit Administration Sections, denied claims under administrative protest or appeal, and those previously denied with finality due to late submission, pending before the courts—provided appellants withdraw their petitions.

Mercado also emphasized the need for timely filing to prevent payment delays and urged more private healthcare facilities to seek PhilHealth accreditation to expand public access to medical services. He assured as well that PhilHealth is committed to faster and fairer claim processing.