PhilHealth to reprocess denied hospital claims starting Nov. 15

MANILA, November 13 ------ The Philippine Health Insurance Corporation (PhilHealth) on Tuesday said it will begin reprocessing previously denied hospital claims starting Nov. 15 until Mar. 31, 2026. These include denied claims that were unprotested or unappealed and were filed late between Jan. 1, 2018, and Dec. 31, 2024.

PhilHealth President and Chief Executive Officer Edwin Mercado said the move acknowledges the challenges faced by hospitals in claim processing. “Alam nating matagal nang hinaing ng mga ospital ang denied claims," he said in a statement. He explained that some of them were not paid due to submission past PhilHealth’s deadline or other administrative reasons. "Hindi fraudulent claims ang mga ito at muling ipo-proseso,” he added.

Citing that PhilHealth is committed to delivering quality healthcare, Mercado said the state insurer needs to know the services rendered by healthcare providers through prompt filing of their claims for faster payment processing. Concerned hospitals were encouraged to coordinate with their respective PhilHealth Regional Offices for detailed guidelines on the reprocessing of denied claims.

Source: pna.gov.ph