PhilHealth Extends Claim Submission Deadline for 2018-2024

PhilHealth has introduced a new policy providing flexibility for health facilities on claims submission deadlines. This significant move addresses the large number of valid claims that were previously denied due to late filing. The policy aims to reduce claim denials, ensure fair reimbursement, and strengthen the partnership between PhilHealth and its accredited health facilities.

This new circular provides a window of opportunity for claims filed between January 1, 2018, and December 31, 2024. It is a direct response to the financial strain and operational issues faced by healthcare providers due to the strict 60-day filing period.

Who is Covered by This New Policy?

This policy applies to claims that were previously denied solely due to late submission. This includes:

• Claims currently with the PhilHealth Regional Office - Benefit Administration Section (PRO-BAS).

• Unprotested and un-appealed denied claims still held by the Health Facility.

• Claims under administrative protest with the PRO-CRC or on appeal with the PARD.

• Claims that were previously denied with finality due to late submission.

It's important to note that this does not apply to claims that were never received by PhilHealth or are still in the possession of health facilities beyond the prescribed filing period.

How to Refile Your Claims

Health Facilities (HFs) must refile affected claims to their respective PhilHealth Regional Offices within six months from the circular's effectivity date. A Transmittal Letter with complete information is required for refiling. For Z Benefit and OHAT packages, the original physical claims and supporting documents must be resubmitted.

Even claims that have been elevated to regular courts can be refiled, provided the appellant withdraws their petition.

Key Takeaways for Health Facilities

• Act Quickly: You have a six-month window to refile your claims.

• Complete Documentation: Ensure all necessary documents are submitted with your refiled claims.

• Compliance is Key: While this policy provides flexibility, fraudulent activities will be met with sanctions.

This new circular is a positive step towards a more efficient and fair healthcare system. It underscores PhilHealth's commitment to its partners and its mandate to provide accessible health services to all Filipinos. Health facilities are encouraged to take advantage of this opportunity to ensure they are fairly compensated for services rendered.

Reference: PC2025-0006