MANILA — The Philippine Health Insurance Corporation (PhilHealth) is planning to implement an artificial intelligence (AI)–powered pre-validation system to detect potentially fraudulent claims and protect its funds.

In a Palace briefing on Wednesday, PhilHealth President and CEO Edwin Mercado said the AI system will review electronically submitted claims to ensure that patients’ lab tests align with their medical diagnoses.

“Kapag pinasok po ‘yung e-claims, made-detect na po kung nagma-match ‘yung diagnosis doon sa mga lab test na ginawa…doon pa lang mapa-flag na namin kung ano ‘yung potentially hindi karapat-dapat,” Mercado explained.

In addition to tech-based safeguards, PhilHealth is strengthening communication with members to make sure patients understand the services and benefits available to them, especially regarding zero-balance billing and basic hospital accommodation.

“Pinapalakas namin ‘yung aming communication program…at i-inform po namin ‘yung mga pasyente kung ano po ‘yung kanilang mga benepisyong dapat natatamasa,” Mercado said.

The AI pre-validation system is expected to be rolled out within the first quarter of 2026, signaling PhilHealth’s push toward fraud prevention and improved transparency.