RE:GOVUnofficial concept30 pages reimagined from www.philhealth.gov.ph by an AI agent · not affiliated with PhilHealthOfficial site ↗ReportFeedbackYou get good benefit claims paid to health care institutions and members within 60 days.
| 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) |
| 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 |
Read from the office's Citizen's Charter by Muse Spark. Fees and steps change: check the PDF and the office before you go.
Citystate Centre, 709 Shaw Boulevard, Pasig City
This website is an unofficial, AI-generated reimagining of www.philhealth.gov.ph produced by RE:GOV for demonstration purposes. It is not operated by, endorsed by, or affiliated with Philippine Health Insurance Corporation or any government body. Content was migrated automatically and may be incomplete or out of date. For official information and services, always use the agency’s official website.
© 2026 Philippine Health Insurance Corporation Public domain Content sourced from www.philhealth.gov.ph
Reimagined by RE:GOV · Oct 27, 2026
