MANILA — The Philippine Health Insurance Corp. (PhilHealth) said its regional offices may provide capacity-building assistance to accredited inpatient health facilities as the agency prepares for the implementation of shadow billing under a Diagnosis-Related Groups (DRG) system.
In Advisory No. 2026-0053, signed Sept. 25, PhilHealth said infirmaries and Level 1 to Level 3 hospitals may coordinate with their respective regional offices for guidance on accomplishing Claim Form 5 (CF5), which will be required under PhilHealth Circular No. 2026-0012.
PhilHealth said the mandatory submission of CF5 for every inpatient claim is intended to familiarize health facilities with the documentation standards that will be used under the DRG system.
Unlike the existing All Case Rates system, the DRG framework collects and processes claims data differently, requiring hospitals to adjust their data management and documentation procedures.
The state health insurer said the transition aims to prepare facilities for the eventual use of DRGs in claims processing and payment.
PhilHealth also encouraged health facilities to review its official resources, including the DRG Implementation Manual and materials from the Philippine Institute for Development Studies-Health Economics and Finance Program.
Hospitals needing further assistance may coordinate with their PhilHealth regional DRG representatives or contact the PhilHealth Corporate Action Center.
