On Jun. 23, 2025, PHI Health reminded that the effectivity period of the policy for flexibility in claims submission deadlines is six months, which ends on Sep. 21, 2025.
It will deny with finality all claims not submitted within the allowed timeframe.
Document dated Jun. 23, 2025, received from PHI Health Jun. 25, summarized Jun. 27.
On Mar. 6, PHI Health issued circular re claims submission deadlines.
PHI Health issued a circular introducing flexibility in claims submission deadlines for claims filed between Jan. 1, 2018 and Dec. 31, 2024, given issues re denied claims.
Outline of Provisions
Addresses 60-day deadline/filing period for benefit claims that resulted in valid claims being returned/denied, causing strain on health facilities and operational inefficiencies.
Applies to previously denied claims solely due to late submission with claim series numbers as proof of receipt by PHI Health, filed from Jan. 1, 2018 to Dec. 31, 2024.
Includes Z Benefit and outpatient HIV/AIDS treatment packages that were denied.
Implementation Process
Affected claims must be re-filed by health facilities to their respective PHI Health regional offices within six months from the circular's effectivity date as below stated.
Claims must be submitted with a transmittal letter containing required data, including series number, member's PIN, admission date, discharge date, and initial filing date.
Un-protested and un-appealed denied claims due to late submission still in possession of health facilities must be submitted within 6 months from the circular's effectivity.
After stated period, PHI Health will deny with finality all un-protested and un-appealed claims covered by this policy; does not apply to claims already beyond the prescribed filing period, never received by PHI Health, or still in possession of health facilities.
Does not cover claims related to primary care benefits (PCB), PHI Health Konsulta Benefit Package, or other specific benefit packages with separate filing guidelines.
Effectiveness
The circular takes effect fifteen days after publication, i.e. from Mar. 21, 2025.
Mar. 19, 2025 Revision to Annex B
On Mar. 19, 2025, PHI Health revisedannex B of Mar. 6 circular above, outlining the documentary requirements for reprocessing claims denied due to late submission.
PHI Health said reprocessing applies to un-appealed as well as un-protested eClaims (with claim series numbers) still in possession of health facilities, Z benefit packages and PhilHealth outpatient HIV/AIDS treatment (which are referred to as OHAT) claims.
In addition, revised annex B specifies an additional requirement with respect to denied claims due to late submission that are elevated and pending in the regular courts.
Jun. 2025 Reminder
On Jun. 23, 2025, PHI Health reminded that the effectivity period of the policy for flexibility in claims submission deadlines is six months, which ends on Sep. 21, 2025.
It will deny with finality all claims not submitted within the allowed timeframe.
Document dated Jun. 23, 2025, received from PHI Health Jun. 25, summarized Jun. 27.
