At a glance
- Office: Philippine Health Insurance Corporation
- Classification: Highly Technical
- Who may apply: Health Care Institutions
- Total fees: None
- Total processing time: 60 days
Requirements
| Requirement | Where to get it |
|---|---|
| 1. For HCIs: CSF (1 scanned copy) | Health Care Institutions (HCIs) |
| 2. SOA (1 scanned copy) | Health Care Institutions (HCIs) |
| 3. CF4 (1 scanned copy) | Health Care Institutions (HCIs) |
| 4. Other required documents depending on the illness | Health Care Institutions (HCIs) |
| 5. For members filing directly: CSF (1 original copy) | Health Care Institutions (HCIs) |
| or (1 original copy) | Health Care Institutions (HCIs) |
| Complete hospital records (1 original copy) | Health Care Institutions (HCIs) |
Steps
| What you do | What the office does | Fee | Time |
|---|---|---|---|
| For Health Care Institutions | Receive the documents (Claims Assignor) | None | 1 day |
| Assess Claim (Claims Assignor) | None | 1 day | |
| None | Medical Prepayment Review (Medical Evaluator) | None | 5 days |
| Assign eClaims/Post MPR (Claims Processing Chief/Designated) | None | 5 days | |
| Adjudication of Claims (Adjudicator) | None | 10 days | |
| Payment Approval/Generate Benefits Disbursement Vouchers (Claims Processor) | None | 5 days | |
| Certify budget and Funds available/account codes proper (Budget Officer/Accounting Chief) | None | 5 days | |
| Payment Generation (ACPS) (Cashier) | None | 5 days | |
| Generate and prepare voucher if paid (Voucher processor) | None | (If paid) 7 days | |
| If for return to hospital, review and prepare transmittal for mailing (Adjudicator) | None | (If RTH/Denied) 13 days | |
| Crediting to PhilHealth Servicing Bank (Cashier) | None | 3 days | |
| For members filing directly: Submission of Claims | Receive the documents (Receiving clerk) | None | 1 day |
| None | Assess Claim (Claims Assignor) | None | 1 day |
| Medical Prepayment Review (Medical Evaluator) | None | 5 days | |
| Assign eClaims/Post MPR (Claims Processing Chief/Designated) | None | 5 days | |
| Adjudication of Claims (Adjudicator) | None | 10 days | |
| Payment Approval/Generate Benefits Disbursement Vouchers (Claims Processor) | None | 5 days | |
| Generate and prepare voucher if paid (Voucher processor) | None | (If paid) 7 days | |
| Certify budget and Funds available/account codes proper (Budget Officer/Accounting Chief) | None | 8 days | |
| If for return to member, review and prepare transmittal for mailing (Adjudicator) | None | (If RTH/Denied) 12 days | |
| Prepare Check under Member's Name (Cashier) | None | 3 days | |
| Mail/Send Check to Member (Cashier) | None | 3 days |
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.