ILOILO City – In a move seen as a major relief for healthcare institutions, the Philippine Health Insurance Corporation (PhilHealth) Western Visayas has initiated a review and reimbursement of over P591.91 million worth of previously denied claims due to late filing — a step that could ease the financial burden on hospitals and health facilities still reeling from pandemic-era pressures.
A total of 82,353 claims, initially denied for breaching the 60-day filing rule, are now eligible for reimbursement under PhilHealth Circular 2025-0006, which took effect on March 21.
“The purpose of this policy is for us to pay hospitals with denied claims that were denied previously because of late filing,” said PhilHealth-6 public affairs unit head Janime Jalbuna.
The reconsideration period spans from January 1, 2018 to December 31, 2024 — effectively covering the era when PhilHealth transitioned to electronic claims filing. Under current rules, reimbursement claims must be filed within 60 days after patient discharge, with the system automatically rejecting late submissions.
With the new policy, however, hospitals, clinics, and healthcare providers have until September 22, 2025 to resubmit eligible denied claims, offering a critical six-month window for recovery.
“These would even include our Z-benefit package and outpatient HIV-AIDS treatment package as long as they file the claims within the same period – Jan. 21, 2018 to Dec. 31, 2024. Under the policy, they can file up to six months since the circular took effect, which means they can file until Sept. 22, 2025,” Jalbuna explained.
The reconsideration applies not only to routine benefit claims but also those under administrative protest or under review in PhilHealth’s claims review and appeals units.
If health providers fail to refile within the prescribed period, however, Jalbuna warned that “PhilHealth will deny their claims with finality.”/PN