PhilHealth: Hospitals must file claims within 60 days

MANILA, Philippines — State health insurer Philippine Health Insurance Corp. (PhilHealth) is reminding its accredited health care providers that the filing of claims for reimbursements returns to the usual 60 calendar days from a patient’s discharge.

The return to the 60-day filing period will cover all claims for patients with admission date starting Jan. 1, 2023.

The reminder was issued after the declaration of state of calamity due the COVID-19 pandemic ended on Dec. 31, 2022.

This consequently ended certain special privileges being granted to health care facilities during fortuitous events under PhilHealth Circular 2020-0007, such as extended submission of claims from 60 to 120 calendar days.

With the lapsing of the state of calamity declaration, the 45-day limit and single period of confinement rule are likewise reinstated starting 2023 in accordance with PhilHealth Advisory No. 2023-0012.

“We urge all our partner hospitals to start submitting their claims within the usual 60 calendar days as provided for in Section 46, Rule II of Republic Act 7875, as amended by RA 9241 and RA 10606 as amended for their admitted patients starting Jan. 1 of this year,” PhilHealth chief Emmanuel Ledesma Jr. said.

He added the state agency remains committed to process and pay the claims within the 60-day period as required under the law.

“In order to prevent cases of claims denied or sent back to hospitals, we’re raising the awareness of providers and billing personnel regarding the policy, so there will be more defective claims and tedious procedures,” Ledesma said.

“It’s important to facilitate the claims of partner hospitals so they can be paid in accordance with applicable laws and regulations followed by PhilHealth as a government agency,” he added.

Ledesma also urged the hospitals to coordinate with their respective PhilHealth Regional Offices to continue with reconciling claims data and for other assistance that they may need.

In 2022, PhilHealth recorded an average turnaround time of 29 days in paying claims.

It also reported benefit payouts amounting to P129.6 billion as of Dec.31, 2022.