PhilHealth will begin to pay in 15 days almost P9 billion in previously denied claims of accredited hospitals due to late filing, the state health insurer on Thursday said.
PhilHealth President and CEO Edwin Mercado the P8.8 billion is part of the P59.6 billion total in unpaid claims.
“Ensuring access to healthcare is a coordinated effort, with PhilHealth helping to ease the financial burden…At the same time, we need to be aware of the services provided by healthcare facilities. That’s why we continue to remind them to file claims on time so we can process payments more efficiently,” he said.
Mercado said from January 2018 to December 2024, there are about 1.1 million unpaid claims logged, of which about 30 percent are due to the late filing of hospitals.
Since the state health insurer shifted to an electronic filing, claims of hospitals filed beyond the 60-day period were automatically denied.
For the rest of the unpaid claims, Mercado said PhilHealth will give hospitals six months from March 21 to resubmit their denied claims.
Claims currently under administrative protest, appeal, or pending in court may also be reprocessed if hospitals withdraw their legal petitions.
With the new policy, Mercado urged more private hospitals to get accredited.
“We need more partners, especially those in the private sector. We assure you that we will be faster and will exercise fairness in the payment of claims,” he said.
Meanwhile, Mercado assured the public PhilHealth has accountability systems to hold its people accountable.
“We will continue to evaluate our staff, officers, and board members,” he said following Supreme Court Associate Justice Antonio Kho Jr.’s opinion that it may be time to overhaul the board of PhilHealth amid concerns over the utilization of its budget.
Kho said the state health insurer must urge the President to reverse the transfer of P60 billion in PhilHealth “excess funds” to the national treasury.
“Probably, it’s time to overhaul PhilHealth and change the board for not complying with what the law requires,” he said.
The magistrate said the P60 billion could be used to expand the state insurer’s benefits packages to “answer to the public’s needs.”
Petitions were filed by 1Sambayan Coalition, a group led by Senate Minority Leader Aquilino Koko Pimentel III and another group led by Bayan Muna party-list chair Neri Colmenares to stop the transfer of P89.9 billion in excess funds from PhilHealth to the national treasury.
However, P60 billion in unutilized funds were already transferred, with only P29.9 billion remaining with PhilHealth.
The Supreme Court in October issued a restraining order to stop the transfer of the remaining P29.9 billion.