At a glance
- Office: Philippine Health Insurance Corporation
- Classification: Simple
- Who may apply: HCPs (doctors & facilities), OFW, member beneficiaries and their dependents
- Total fees: None
- Total processing time: 31 Minutes
Requirements
| Requirement | Where to get it |
|---|---|
| For HCIs: Claim Summary Form (CSF) - 1 scanned copy | Health Care Institution's (HCIs)/Health Care Providers (HCPs) - PhilHealth Accredited |
| Statement of Account (SOA) - 1 scanned copy | Health Care Institution's (HCIs)/Health Care Providers (HCPs) - PhilHealth Accredited |
| Claim Form 3 (CF3), Maternity Related as may be applicable - 1 scanned copy | Health Care Institution's (HCIs)/Health Care Providers (HCPs) - PhilHealth Accredited |
| Claim Form 4 (CF4) - 1 scanned copy | Health Care Institution's (HCIs)/Health Care Providers (HCPs) - PhilHealth Accredited |
| Other required documents depending on the illness (1 scanned copy) | Health Care Institution's (HCIs)/Health Care Providers (HCPs) - PhilHealth Accredited |
| Clinical Chart , Laboratories, X-Ray | Health Care Institution's (HCIs)/Health Care Providers (HCPs) - PhilHealth Accredited |
| Claim Summary Form (CSF for COVID Testing) | Health Care Institution's (HCIs)/Health Care Providers (HCPs) - PhilHealth Accredited |
| For members filing directly: Claim Form 1/Claim Form 2 (CF1/CF2) - 1 original copy | Health Care Institution's (HCIs)/Health Care Providers (HCPs) - PhilHealth Accredited |
| Original Receipt (OR) - 1 original copy | Health Care Institution's (HCIs)/Health Care Providers (HCPs) - PhilHealth Accredited |
| Complete hospital records - 1 original copy | Health Care Institution's (HCIs)/Health Care Providers (HCPs) - PhilHealth Accredited |
| Statement of Account (SOA) - 1 original copy | Health Care Institution's (HCIs)/Health Care Providers (HCPs) - PhilHealth Accredited |
| Waiver - 1 Original copy | Health Care Institution's (HCIs)/Health Care Providers (HCPs) - PhilHealth Accredited |
Steps
| What you do | What the office does | Fee | Time |
|---|---|---|---|
| For HCIs: Submission of claims ( E-Claims) *Claims may be filed within 60 days from the date of confinement of the patient HCI submits E-Claims through Certified Service Providers | Received the claims through the Certified Service Providers (Claims Assignor) | None | 1 Hour |
| For members Filing Directly : *Claims may be filed within 60 days from the date of confinement of the patient * Claims Confinement Abroad may be filed with 180 days from the date of confinement 1. Secure information and/or queuing number at the Public Assistance Desk or if applicable, Special Lane Section for PWDs/ pregnant women and Senior Citizens | Direct client/s to the appropriate front line service. Provide the priority number to client/s. (Public Assistance Staff) | None | 1 Minute |
| When priority number is called, proceed to Frontline Service Counter and submit claims together with the transmittal list | Receive and screen claims as to the correct number and names of claimants against transmittal list. | None | – |
| Affix initials to copy of transmittal list, if with correction. | Stamp "received" on the transmittal list if there are no deficiencies in the transmittal and total number of claim; if there is/are name/s listed but no claims attached, cross-out name/s in the list and have the transmittal list initialed by the hospital representative/health care provider. | None | – |
| Receive copy of acknowledged transmittal list | Return received copy of transmittal list to hospital representative/health care provider and advise client that processing of claims will be done within the 60-day period (Receiving Clerk) | None | 30 minutes for every 100 Claims |
Source
Read from the office's Citizen's Charter by Muse Spark. Fees and steps change: check the PDF and the office before you go.