The Philippine Health Insurance Corporation now requires accredited inpatient facilities to attach Claim Form 5 to claims for patients discharged on or after August 1.

The requirement covers infirmaries and level 1 through level 3 hospitals. PhilHealth’s advisory says a claim submitted without a valid CF5 will not be accepted. The form collects diagnoses, procedure codes and newborn information that existing claim documents do not fully capture.

For now, the form supports “shadow billing,” in which the insurer groups cases under a developing Philippine diagnosis-related-group system without interrupting reimbursement under the existing All Case Rates framework. PhilHealth’s implementation manual says the collected data will help test and refine the future payment model.

The change primarily affects hospital documentation and electronic claims processing; it is not an announcement that patient benefits or reimbursement rates changed on August 1. Facilities remain responsible for recording information consistent with the attending physician’s documentation and submitting claims through PhilHealth’s electronic platform.

Source: PhilHealth Advisory 2026-0036 — philhealth.gov.ph source ↗

Source: PhilHealth, Philippine Diagnosis-Related Groups implementation manual — philhealth.gov.ph source ↗

Source: PhilHealth 2026 advisories index — philhealth.gov.ph source ↗