Electronic Claims Submission System

The Project's Phase II where in encoded claims information in the hospital systems particularly in claims forms 1 & 2 can now be submitted online via the PhilHealth Web Service which will eventually provide Institutional Health Care Provider (IHCP) to view status of their claims online. It is intended to reduce the turned around time (TAT) and improved operational efficiency in the processing/payment of claims.

Pre-Qualifications

The hospital facility:

1.) Must be Phase I users or currently online and utilizing the CEWS. Newly interested hospital participants must first implement the CEWS before they could utilize Phase II and III of the e-Claims Project.

2.) Must have an existing Hospital Information System (HIS) and internet connection. The HIS are consists of patient information, details of confinement and hospital charges (pharmacy, laboratory & supplies).

3.) Should be capable to develop their own ECS Phase II system prototype which is capable of creating an electronic claim form that contains data and information similar to the parameters of PhilHealth Claim Forms 1 and 2. These data and information shall be converted to an Extensible Markup Language (XML), file and shall be uploaded to PhilHealth e-Claims Web Service.

4.) Is able and willing to implement the program under the terms and conditions set by the Corporation.

How to apply?

1. Download and fill out Health Care Provider Account Profile (HCPAP) application form

2. Email or fax the filled out HCPAP to PhilHealth Regional Office (PhRO) for processing and approval.

3. PhilHealth will e-mail to the hospital authorized contact person the e-Claims Web Service Package and the USER'S GUIDELINES on how to connect to PhilHealth Web Service.

Here's how the program works..

1.) Interested phase I IHCPs shall notify PhilHealth their interest to avail the Phase II service by submitting a letter of intent to PhilHealth Regional Office (PhRO).

2.) Hospital must inform PhilHealth Network Group (PNG) at network@philhealth.gov.ph and PhRO through e-mail upon development of an XML claim file for test uploading. IHCP must use test XML file for the test upload.

3.) PhilHealth shall evaluate the ECS prototype developed by hospital through the e-Claims Portal. The portal will facilitate checking of the valid parameter values, document type definition (DTD) validation and completeness of the XML file.

4.) The web service will issue a sixteen (16) digit Transmittal Control Number (TCN), after a successful test upload of XML claim file to the e-Claims Portal.