Document Code

ABRA PROVINCIAL HOSPITAL QP-APH-2020-PECS

QUALITY PROCEDURE Proc. No.
01
Eff. Date
02.17.2020
Page
1 of 2

PROCESSING AND SUBMISSION OF CLAIMS

PROCEDURE TITLE
OF ELIGIBLE PHILHEALTH MEMBER/DEPENDENT
This process starts from the receipt of discharged patient’s records from
SCOPE _____, to filling-out of Claim forms and uploading of supporting documents,
up to submission of Claims of Eligible PhilHealth Member/Dependent
To define the standard procedures of processing and submission of
PURPOSE
PhilHealth claims.
PROCESS DESCRIPTION:
INPUT PROCESS OUTPUT
Filling out of forms and
Records of Eligible Philhealth uploading of documents Submitted PhilHealth Claims.
Patients online.
DESCRIPTIVE STATEMENT:
The ____ section will forward the patients records along with completely fill-out forms to the E-
Claims Section for processing of claims to be submitted to PhilHealth.

Step Responsible PROCESS/

Details References
No. Personnel ACTIVITY

1 Receiving Clerk – Receipt of complete  Receive patient’s chart Chart with

E-Claims Section patient’s record or chart and check completeness supporting
of records and verify if documents and
forms are properly filled- forms.
out.

2 Data uploading to E-claims  Upload online of PhilHealth Claim

system. member/patient or Forms
dependent/patient
information

3 Filling out of PhilHealth  PhilHealth claim forms PHC Claim Form 1,

Claim Forms are filled-out indicating 2, 3, and 4
member/patient or
dependent/patient
information:

a. Claim Signature
Form – CSF Form 1
b. Claim Form 2
c. Claim Form 3
d. Claim Form 4

4 Document uploading  Scan PhilHealth Claim PHC Claim Form 3

Form 3 and 4 and other and 4
supporting documents.

A. For patients admitted

without procedures
results or records for
services rendered i.e.
Laboratory, X-Ray,
Ultz, CT-Scan are
scanned and
uploaded to the

THIS DOCUMENT IS CONTROLLED AND NOT TO BE REPRODUCED WITHOUT AUTHORIZATION

 Document Code
ABRA PROVINCIAL HOSPITAL QP-APH-2020-PECS
QUALITY PROCEDURE Proc. No.
01
Eff. Date
02.17.2020
Page
2 of 2

Step Responsible PROCESS/

Details References
No. Personnel ACTIVITY
system.

B. For patients who were

admitted with
procedure records for
services rendered
including all OR Memo,
OR Technique,
Anesthesia Records are
scanned and uploaded
to the system.

5 Filling-out of PhilHealth Upon successful online Claiming Series

Claiming Series Number on submission, the system will Number
the CF Forms generate a claiming series
number to be written on
the Claim Forms before
filing.

6 Filing of records Forms and Records Patients Records

submitted are filed
temporarily at the E-Claims
Section pending approval of
claim.

Definition of Terms:
Legal References

PREPARED BY: REVIEWED AND RECOMMENDED BY:

JOSELITO B. VALERA ROSAURO VINCENT P. SEARES, M.D.

Dental Aide I – Detailed Chief of Clinics
PROCESS OWNER IMMEDIATE SUPERVISOR

Approved by:

APH Quality Management Team

THIS DOCUMENT IS CONTROLLED AND NOT TO BE REPRODUCED WITHOUT AUTHORIZATION