PhilHealth-7 preps for new payment system

CEBU, Philippines — PhilHealth-7 is intensifying preparations for the nationwide shift to a Diagnosis-Related Group (DRG)-based payment system under the UHC Act.

Philhealth-7 said that it is engaging hospital personnel in technical orientations and policy discussions to improve efficiency, transparency, and compliance in healthcare facilities across Central Visayas.

Central to the transition is the implementation of the Philippine Diagnosis-Related Groups (PHL-DRGs), which will classify hospital cases based on patients’ diagnoses and the resources used in their treatment.

PhilHealth-7 said healthcare facilities are required to submit complete and reliable clinical information through Claim Form 5 (CF5) to ensure accurate classification of inpatient cases.

Under PhilHealth Advisory No. 2026-0036, submission of CF5 became mandatory for patients discharged starting August 1, 2026. Claims without a valid CF5 attachment will no longer be accepted for processing.

To help hospitals meet the new requirements, the PhilHealth-7 Health Care Delivery Management Division conducted a “Retooling on the Shadow Billing of Diagnosis-Related Groups (DRG)” on August 19 at the Golden Prince Hotel and Suites in Cebu City.

The activity was attended by representatives of Level 2 and Level 3 hospitals, which are key sources of inpatient claims data needed for the implementation of the DRG system.

The retooling focused on shadow billing, a transitional mechanism that allows hospitals to generate simulated DRG claims alongside the existing All Case Rates claims.

Participants were also briefed on electronic CF5 submission, coding requirements and compliance guidelines to help ensure a smooth transition to the dual-track billing process while maintaining uninterrupted claims processing and reimbursement.

Participating hospitals sent multidisciplinary teams composed of DRG point persons, claims processors, information technology personnel, and physicians or medical evaluators.

PhilHealth-7 said the activity builds on previous technical discussions conducted for government hospitals, private health facilities and infirmaries across Central Visayas.

As the agency moves closer to full implementation of the DRG payment system, it continues to strengthen the capacity of health facilities and provide technical assistance to ensure institutional readiness.