PhilHealth reminds hospitals to file claims within 60 days starting this year

State health insurer Philippine Health Insurance Corporation (PhilHealth) recently reminded all its accredited health care providers in the country that 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 January 1, 2023.

The reminder was issued after the Declaration of State of Calamity due the Covid-19 pandemic ended on December 31, 2022, which 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 said discontinuance of State of Calamity, 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 January 1 of this year,” PhilHealth Chief Emmanuel R. Ledesma, Jr. said, adding that the state agency remains committed to process and pay the claims within the 60 day period as required under the law.

“Para maiwasan naman ang mga claims na denied o bumabalik sa ospital, patataasin natin ang kaalaman ng mga providers at billing personnel patungkol sa ating mga polisiya para maiwasan ang mga depektibong claims at ang pabalik-balik na proseso,” Ledesma assured the hospitals. “Mahalaga na maayos ang claims ng ating partner hospitals para mabayaran ang mga ito batay sa mga aplikableng batas at regulations na sinusunod ng PhilHealth bilang isang 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 to best serve PhilHealth members and their families.

In 2022, PhilHealth recorded an average turn-around time of 29 days in paying claims. It also reported benefit payouts amounting to P129.6 billion as of December 31, 2022.