PhilHealth claim returned to hospital (RTH): what to fix and refile
This page is for a hospital or clinic billing clerk whose PhilHealth claim came back "Return to Hospital" (RTH), often because the Claim Signature Form (CSF) was unsigned or incomplete, and for a member asked to sign again. At the end you will know why claims are returned, how long you have, and who signs each part of the CSF.
PhilForms fills the claim forms. It does not file them: the hospital files the claim with PhilHealth.
Who files a claim, and by when
The health facility files the claim, not the patient. PhilHealth's 2026 circular on short admissions says there is no direct filing of claims by members or their dependents; all claims are filed by the health facility (PhilHealth Circular 2026-0013, V.D.6). PhilHealth's FAQ on maternity care names the exceptions where a patient files: confinement abroad and emergencies in non-accredited facilities (Tamang Sagot on PC 2026-0005, question 14).
Window · Rule · Source; Filing the claim · Within 60 calendar days from the date the patient was discharged; PhilHealth may extend it for reasonable causes · RA 10606, sec. 25 (new sec. 35 of RA 7875); the same line is printed on Claim Form 2; Answering an RTH notice · Within 60 calendar days from receipt of the notice, unless PhilHealth extends it · PhilHealth Circular 2026-0013, V.E.13
Why a claim is returned to the hospital
PhilHealth applies the "return to hospital" policy to claims with incomplete requirements, discrepancies in the supporting documents or attachments, or incompletely filled-out forms, for compliance within the period above (PhilHealth Circular 2026-0013, V.E.13). The CSF itself warns at the top: "All information required in this form are necessary. Claim forms with incomplete information shall not be processed" (Claim Signature Form, revised September 2018).
PhilHealth's own advice to facilities is to make sure every claim requirement is complete, the supporting documents have no errors, and every form is properly filled out before submission (Tamang Sagot on PC 2026-0005, question 21).
Who signs each part of the CSF
Read the RTH notice first: it says what is lacking. If it is the CSF, check each part against the form (Claim Signature Form):
Part · What it is · Who signs; I. Member and patient information and certification · Member's PIN and name, the patient, the confinement dates · The member, or the member's representative (tick the relationship and the reason: member incapacitated, or another reason). A member or representative who cannot write puts a right thumbmark, assisted by an HCI representative; II. Employer's certification · For employed members only: PEN, business name, the contribution certification · The employer or its authorized representative, with designation and date; III. Consent to access patient records · Consent to PhilHealth examining the medical records · The member, patient or authorized representative (thumbmark rule as in Part I); IV. Health care professional information · Up to three professionals · Each professional: accreditation number, signature over printed name, date signed; V. Provider information and certification · First and second case rate (ICD-10 or RVS code) · The authorized HCI representative, with designation and date
Every signature has a "Date Signed" beside it. A blank date next to a signature is an incomplete form.
Step by step: fixing an RTH for an unsigned CSF
1. Open the RTH notice and list each deficiency it names. 2. Fill a clean Claim Signature Form with the same member, patient and confinement dates as the claim. 3. Get each missing signature and date from the person in the table above. For a member who cannot sign, use the representative lines and tick the reason. 4. Check the CSF against Claim Form 2 and Claim Form 1: names, PINs and dates must match. A mismatch is a discrepancy, the other ground for RTH. 5. Send the compliance back within 60 calendar days from receiving the notice.
For a senior citizen who was not enrolled before discharge, PhilHealth's senior page says to attach a filled-out PMRF and proof of senior status (such as the senior citizen ID) to the usual claim documents (PhilHealth: Senior Citizens).
Denied claims
A denied claim is not an RTH. The facility may file a motion for reconsideration and appeal claims PhilHealth denied, following PhilHealth's existing rules (PhilHealth Circular 2026-0013, V.D.8). The rules on late filing still apply, except when the delay comes from a natural calamity or another fortuitous event (same circular, V.D.7).
Mistakes that send a claim back
- A signature with no "Date Signed". - Part II left blank for an employed member, or filled for a member who is not employed. - The representative signed but the relationship and the reason are not ticked. - A thumbmark with no HCI representative assisting. - Names, PINs or confinement dates that differ between the CSF, CF-1 and CF-2.
Questions
Na-RTH ang claim namin dahil unsigned ang CSF. Ano ang gagawin?
Read the RTH notice for what is missing, get the missing signatures and dates on the CSF from the member or representative, the employer, the professionals and the HCI representative, and send it back within 60 calendar days from receiving the notice (PC 2026-0013).
Sino ang pipirma sa CSF kung hindi kaya ng member?
The member's representative signs Part I and ticks the relationship and the reason. A member or representative who cannot write puts a right thumbmark, assisted by an HCI representative, as the form says.
Is the employer's part needed for every member?
No. Part II is for employed members only, the form says. Leave it for a member who is not employed.
Pwede bang ang pasyente mismo ang mag-file ng claim?
As a rule, no: the health facility files the claim. PhilHealth's FAQ names confinement abroad and emergencies in non-accredited facilities as the cases where a patient files.
What is the difference between an RTH and a denied claim?
An RTH asks the hospital to complete or correct the claim within 60 calendar days. A denied claim can be answered with a motion for reconsideration or an appeal.
Last checked 2026-10-23. Not affiliated with BIR, SSS, PhilHealth, Pag-IBIG or any government agency.