PHILHEALTH Regional Office (PRO) 7 continues to advance its transition toward a better provider payment mechanism under the Universal Health Care (UHC) Act by engaging key hospital personnel in comprehensive technical orientations and policy discussions aimed at improving efficiency, transparency, and administrative compliance across health facilities in Central Visayas.
Central to this transition is the rollout of the Philippine Diagnosis-Related Groups (PHL-DRGs), a new provider payment mechanism designed to classify hospital cases according to diagnosis and resource utilization. To support the accurate classification of inpatient cases under the DRG system, PhilHealth requires healthcare facilities to submit complete and reliable clinical data through Claim Form 5 (CF5). Accordingly, under PhilHealth Advisory No. 2026-0036, the submission of CF5 is mandatory for patients discharged beginning August 1, 2026. Claims submitted without a valid CF5 attachment will no longer be accepted for processing.
To help hospitals comply with these new requirements, PRO VII Health Care Delivery Management Division conducted the "Retooling on the Shadow Billing of Diagnosis-Related Groups (DRG)" on August 19, 2026, at the Golden Prince Hotel and Suites in Cebu City. The activity specifically targeted Level 2 and Level 3 hospitals, which serve as key sources of inpatient claims data necessary for the full implementation of the DRG system.
The retooling session built on earlier capacity-building activities conducted across the region and focused on strengthening participants' understanding of shadow billing, a transitional mechanism that allows healthcare providers to generate simulated DRG claims alongside existing All Case Rates claims. Through detailed discussions on electronic CF5 submission, coding requirements, and compliance guidelines, participants gained practical knowledge to support the smooth adoption of the dual-track billing process while maintaining uninterrupted claims processing and reimbursement operations.
Participating hospitals sent multidisciplinary teams composed of DRG point persons, claims processors, information technology personnel, and physicians or medical evaluators, ensuring alignment across both clinical and administrative functions.
The orientation follows a series of technical discussions previously conducted for government hospitals, private health facilities, and infirmaries throughout Central Visayas. As PhilHealth moves closer to the full implementation of the DRG payment system, the Regional Office continues to strengthen institutional readiness and stakeholder engagement to support a more responsive, data-driven, and equitable healthcare financing framework.
Under the leadership of Acting Regional Vice President Jenet Ann Advincula, PhilHealth Regional Office VII remains committed to providing continuous policy guidance, technical assistance, and operational support to health facilities as they prepare for the nationwide transition envisioned under the Universal Health Care program. (PR)