PhilHealth to process over P8 billion in denied claims | ABS-CBN
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PhilHealth to process over P8 billion in denied claims
PhilHealth to process over P8 billion in denied claims
MANILA — State health insurer PhilHealth is set to to process and settle denied claims amounting to P8.8 billion.
MANILA — State health insurer PhilHealth is set to to process and settle denied claims amounting to P8.8 billion.
In his first press conference as PhilHealth chief, Acting President and CEO Edwin Mercado said that following the publication of their policy on Flexibility Claim Reimbursement on Thursday, the agency will begin to process claims within 15 days.
In his first press conference as PhilHealth chief, Acting President and CEO Edwin Mercado said that following the publication of their policy on Flexibility Claim Reimbursement on Thursday, the agency will begin to process claims within 15 days.
The billions of pesos worth of claims comes from a backlog of 1.1 million claims that were denied due to late filing issues from hospitals with the PhilHealth Board.
The billions of pesos worth of claims comes from a backlog of 1.1 million claims that were denied due to late filing issues from hospitals with the PhilHealth Board.
“Denied claims from January 1, 2018 to December 21, 2024, due to the lapse of 60-day period of filing na walang causes of denial, hindi fraudulent claims, ay babayaran (that have no cause for denial, are not fraudulent claims, will be paid),” he said.
“Denied claims from January 1, 2018 to December 21, 2024, due to the lapse of 60-day period of filing na walang causes of denial, hindi fraudulent claims, ay babayaran (that have no cause for denial, are not fraudulent claims, will be paid),” he said.
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The new policy givens health facilities six months to submit claims that had previously been denied due to late filing.
The new policy givens health facilities six months to submit claims that had previously been denied due to late filing.
Among the claims denied that will be subjected for re-processing are:
Among the claims denied that will be subjected for re-processing are:
- Those that are in the possession of the PhilHealth Regional Office Benefit Administration Section
- Denied claims under administrative protest in the PhilHealth Regional Office - Claims Review Committee and/or appeal with Protest and Appeals Review Department
- Claims previously denied with finality according to the current implementing rules and regulation from January 1, 2018 to December 31, 2024
- Claims previously denied with finality due to late submission from January 1, 2018 to December 31, 2024 that have been elevated and are pending before the regular courts, provided that the appellants withdraw their petition against the Corporation.
- Those that are in the possession of the PhilHealth Regional Office Benefit Administration Section
- Denied claims under administrative protest in the PhilHealth Regional Office - Claims Review Committee and/or appeal with Protest and Appeals Review Department
- Claims previously denied with finality according to the current implementing rules and regulation from January 1, 2018 to December 31, 2024
- Claims previously denied with finality due to late submission from January 1, 2018 to December 31, 2024 that have been elevated and are pending before the regular courts, provided that the appellants withdraw their petition against the Corporation.
The PhilHealth chief stressed the importance of prompt filing to avoid any delays in the appropriate compensation that service providers should receive the moment their services have been rendered.
The PhilHealth chief stressed the importance of prompt filing to avoid any delays in the appropriate compensation that service providers should receive the moment their services have been rendered.
Mercado also appealed to more facilities, especially those in the private sector, to get accredited to widen healthcare access, which the public needs especially at this time.
Mercado also appealed to more facilities, especially those in the private sector, to get accredited to widen healthcare access, which the public needs especially at this time.
“Kelangan mas marami po lalo na sa private sector na sumama. Kami ay nangangako na bibilisan namin at magiging patas sa pagbabayad ng claims,” Mercado assured.
“Kelangan mas marami po lalo na sa private sector na sumama. Kami ay nangangako na bibilisan namin at magiging patas sa pagbabayad ng claims,” Mercado assured.
(We need more especially those in the private sector. We assure you that we will be faster and will exercise utmost fairness in the payment of claims.)
(We need more especially those in the private sector. We assure you that we will be faster and will exercise utmost fairness in the payment of claims.)
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