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Everything we know about getting Philippine claims paid

Everything here is free, with no sign up. Start with the six in the PHL-DRG basics reading path, or jump straight to the problem in front of you.

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PhilHealth RTH claims, the complete recovery guide

What a Return to Hospital claim is, the 60 day clock that turns it into a denial, the most common causes, and how to recover the ones you still can.

6 min read · reviewed 2026-08-10

Every PhilHealth claim denial reason, and how to prevent each one

A complete breakdown of why PhilHealth denies or returns hospital claims, grouped by root cause, with the specific prevention step for each category.

4 min read · reviewed 2026-08-10

All guides

Shadow billing explained, what your hospital must file right nowWhat shadow billing is, which facilities must file parallel DRG-format claims now, what each one carries, and how to start without adding headcount.3 min read

PHL-DRG for hospital CFOs, how your payment tier is actually decidedHow PhilHealth PHL-DRG decides what your hospital is paid, why secondary diagnosis codes set the tier, and where the money leaks before a claim is filed.3 min read

CC and MCC markers, the codes that set your payment tierWhat CC and MCC markers are, how the two letters move a PhilHealth claim between payment tiers, and why a documented complication has to reach the claim.3 min read

Zero retention architecture, running clinical AI without storing patient dataHow to run clinical AI without storing patient data: request-scope processing, salted hashing, and what a zero retention architecture proves to a DPO.3 min read

The 60 day RTH clock, and why most hospitals lose itHow PhilHealth counts the 60 day RTH window, why calendar days are what catch hospitals out, and where the days actually go inside a hospital.4 min read

Coding 12 secondary diagnoses without adding headcountDRG claims allow up to 12 secondary diagnoses, and most Philippine hospitals file two or three. How to close that gap using documentation you already have.3 min read

Severe dengue and R57.8, a case study in a missing tierHow a severe dengue admission loses its payment tier when R57.8 is left off the claim, and what the chart already proves about the shock the patient was in.3 min read

The DRG transition, a readiness checklist for Philippine hospitalsWhat to fix before PhilHealth moves fully from case rates to DRG payment, ordered by how long each change takes to show results in your claims.3 min read

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