PhilHealth Reminds Hospitals to File Claims within 60 Days for Reimbursements

Philippine Health Insurance Corporation (PhilHealth), the country’s state health insurer, has reminded all its accredited healthcare providers that they must file claims for reimbursements within 60 calendar days from a patient’s discharge, effective January 1, 2023.

This move marks a return to the pre-pandemic practice, as the state of calamity that allowed for extended submission of claims under PhilHealth Circular 2020-0007 ended on December 31, 2022. Consequently, PhilHealth Advisory No. 2023-0012 reinstates the 45-day limit and single period of confinement rule starting 2023.

PhilHealth Chief Emmanuel R. Ledesma, Jr. emphasized that the agency remains committed to processing and paying claims within the 60-day period mandated by Republic Act 7875, as amended by RA 9241 and RA 10606. To avoid denied or rejected claims, Ledesma urged hospitals to familiarize themselves with PhilHealth’s policies and regulations to ensure that claims are submitted accurately and efficiently.

“Mahalaga na maayos ang claims ng ating partner hospitals para mabayaran ang mga ito batay sa mga aplikableng batas at regulations (It is essential to ensure that our partner hospitals’ claims are properly processed and paid in accordance with applicable laws and regulations),” Ledesma said.

Ledesma also encouraged hospitals to coordinate with their respective PhilHealth Regional Offices for assistance in reconciling claims data and other issues that may arise.

In 2022, PhilHealth recorded an average turnaround time of 29 days in paying claims, with benefit payouts reaching P129.6 billion as of December 31, 2022.