Quick answer
If you submitted your cases on time, you did your part right. 🙂 A payment that is still pending, or an amount that doesn't match what you expected, is resolved with PhilHealth, since PhilHealth is the one who releases the payment.
Here is how it works: the system submits your cases to PhilHealth. PhilHealth pays for them. Once your cases are submitted successfully, the payment sits on PhilHealth's side.
Your proof that the cases were submitted on time is your transmittal IDs.
What to do
Step 1: Download your transmittal records (CSV). These list every case included in your submission, with the transmittal IDs.
See: How to see which cases were included in your Tranche 1 or Tranche 2 Submission
Step 2: File a ticket in PhilHealth's OS Ticket (itsupport.philhealth.gov.ph) using your facility's own account. In the ticket:
- Say which month's payment is pending or doesn't match
- Attach your transmittal records as proof the cases were submitted on time
- Attach your supporting proof that you did the PCU and completed the Digital YES on the HCI portal for those months
- No OS Ticket account yet? See: How to request an account in PhilHealth's ticketing system
Step 3: Contact your LHIO (BAS department). Give them your ticket number, show your transmittal IDs, and ask them to review your submission for that month.
To check what PhilHealth actually counted
To see which patients PhilHealth will reimburse you for, generate your SAP1 Ledger from your IHCP account under YAKAP > SAP Ledger. This is separate from the transmittal CSV, which comes from SeriousMD YAKAP.
See: How to Generate your Statement of Account Payable 1 (SAP1) Ledger
