Filing of Claims | PhilHealth (unofficial RE:GOV concept) · RE:GOV

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GOVPH · Republic of the Philippines

Republic of the PhilippinesPhilippine Health Insurance CorporationSeguridad sa kalusugan para sa bawat Filipino

Filing of Claims

You get your benefit claims received and acknowledged for processing within 60 days.

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

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