NINETEENTH CONGRESS )
REPUBLIC OF THE PHILIPPINES )
Third Regular Session )

HOUSE OF REPRESENTATIVES

Introduced by Representative Rufus B. Rodriguez
House Bit! No. 11410 ~

EXPLANATORY NOTE

Article Il Section 11 of the 1987 Philippine Constitution state that "The State shall adopt
an integrated and comprehensive approach to health development which shall endeavor to
make essential goods, health and other social services available to all the people at affordable
cost. There shall be priority for the needs of the under-privileged, sick, elderly, disabled,
women, and children. The State shall endeavor to provide free medical care to paupers.”

To assist the State in pursuing the aforementioned policy, health institutions were
granted the privilege of applying for accreditation as health facilities (HFs). Under the rules as
promulgated is consonance with RA 7875, Accredited HFs shall extend PhilHealth benefits to
PhilHealth members in the availment of health services and shall reimburse the same with
PhilHealth.

Hence, the State is committed to continuously improving its service delivery and
strengthening partnerships with HFs. A critical area for improvement is the current policy
surrounding PhilHealth’s 60-day filing deadline for benefit claims. Over the years, this rigid
deadline has led to a significant number of valid claims being returned and denied, causing
financial strain on HFs which is currently pegged at a staggering 20 Billion Pesos, and creating
operational inefficiencies within PhilHeaith’s system.

The Supreme Court’s decision in G.R. No. 163123 (PhilHealth vs. Chinese General
Hospital and Medical Center) highlighted the necessity of adopting a more fiexible approach
to claims processing. The Court emphasized that strict procedural rules should not undermine
the core objective of the National Health Insurance Program (NHIP), which is to ensure
financial access to essential health services for all Filipinos.

Section 46 of the Implementing Rules and Regulations (IRR) of RA 7875, as amended,
explicitly states:

“All claims for reimbursement or payment for services rendered shall be
filed within a period of sixty (60) calendar days from the date of discharge
of the patient from the health care provider. The period to file the claim may
be extended for such reasonable causes as may be determined by the

Corporation."

This provision underscores PhilHealth’s authority to extend the filing period for claims
when justified by reasonable causes. The intent behind this flexibility is to ensure that Health
Facilities are fairly compensated for the services they render, even when delays in claim
submission occur due to circumstances beyond their control.

This bill seeks to address the issue of the 60-day filing period of claims with PhilHealth
which proves to be unreasonable and debilitating to the healthcare industry.

In view of the foregoing, approval of this bill is earnestly sought.



NINETEENTH CONGRESS
REPUBLIC OF THE PHILIPPINES )
Third Regular Session )

HOUSE OF REPRESENTATIVES

Introduced by Representative Rufus B. Rodriguez

House Bill No. 11410

AN ACT
LENGTHENING THE PERIOD OF FILING OF REIMBURSEMENT CLAIMS WITH THE
PHILIPPINE HEALTH INSURANCE CORPORATION (PHILHEALTH), AMENDING
REPUBLIC ACT 7875 FOR THE PURPOSE

Be it enacted by the Senate and House of Representatives of the Philippines in Congress
assembled:

SECTION 1. Short Title -— This act shall be known as the “Extending the PhilHealth Claims
Filing Period Act”

SECTION 2. Declaration of Principle — It is the policy of the State to adopt an integrated and
comprehensive approach to health development which shall endeavor to make essential
goods, health and other social services available to all people at affordable cost.

SECTION 3. Amendment of Republic Act 7875, as amended. - Section 35 of Republic Act
7875, as amended, is hereby amended to read as follows:

“SEC. 35. Reimbursement and Period to File Claims. — All claims for
reimbursement or payment for services rendered shall be filed within a period of
one hundred and twenty (120) calendar days from the date of discharge of the
patient from the health care provider.

The period to file the claim may be extended for such reasonable causes
determined by the Corporation.”

SECTION 4. Implementing Rules and Regulations - PhilHealth shall promulgate the
necessary rules and regulations for the proper implementation of this Act not later than thirty
(30) days from its effectivity.

SECTION 5. Separability Clause — If any provision or part of this Act is declared
unconstitutional, the remaining parts or provisions not affected shall remain in full force and
effect.

SECTION 6. Repealing Clause. - All laws, executive orders, rules and regulations, and
issuances or parts thereof which are inconsistent to and contrary with the provisions of this
Act are hereby repealed and amended accordingly.

SECTION 7. Effectivity. -— This Act shall take effect fifteen (15) days after its publication in
the Official Gazette or in a newspaper of general circulation.

Approved,