Updated Requirements for PhilHealth Accreditation for Doctors, Midwives and Dentists

In the Philippines, health care providers are encouraged to get PhilHealth, the country's premier insurance system provided by the government, accreditation. Accreditation is a process whereby the qualifications and capabilities of health care providers are verified in accordance with the guidelines, standards and procedures set by the PhilHealth.

PhilHealth accreditation for professionals will enable them to participate in the National Health Insurance Program.  Furthermore, it helps ensure that health care services rendered by them are of the desired and expected quality.

Physicians, dentists and midwives may apply for PhilHealth accreditation.

Requirements:

1. General Practitioner
a. Initial accreditation: 

• Provider Data Record for professionals 
• Performance Commitment 
• Updated PRC license or its alternative 
• 1 x 1 photo – 2
•  Proof of Payment of Premium Contribution

b.  For continuous accreditation and re-accreditation due to gap:

• Provider Data Record forprofessionals
• Performance Commitment
• Updated PRC license or its alternative
• 1 x 1 photo – 2
• Proof of Payment of Premium Contribution

c. For re-accreditation (upgrading from GP to MS):

• Provider Data Record for professionals
• Performance Commitment
• Updated PRC license or its alternative
• 1 x 1 photo – 2
• Proof of Payment of Premium Contribution (if application is for continuous accreditation and upgrading at the same time)
• Specialty Board Certificate

2. General practitioner with training

a. Initial accreditation:

• Provider Data Record for professionals 
• Performance Commitment 
• Updated PRC license or its alternative 
• 1 x 1 photo – 2 
• Proof of Payment of Premium Contribution 
• Completed Residency Training Certificate

b. For continuous accreditation and re-accreditation due to gap:

• Provider Data Record for professionals
• Performance Commitment
• Updated PRC license or its alternative
• 1 x 1 photo – 2
• Proof of Payment of Premium Contribution

c. For re-accreditation (upgrading from GP to MS):

• Provider Data Record for professionals 
• Performance Commitment 
• Updated PRC license or its alternative 
• 1 x 1 photo – 2 
• Proof of Payment of Premium Contribution
• Specialty Board Certificate

3. Medical Specialist

a. Initial accreditation:

• Provider Data Record for professionals 
• Performance Commitment 
• Updated PRC license or its alternative 
• 1 x 1 photo – 2 
• Proof of Payment of Premium Contribution 
• Specialty Board Certificate

b. For continuous accreditation and re-accreditation due to gap:

• Provider Data Record for professionals
• Performance Commitment 
• Updated PRC license or its alternative 
• 1 x 1 photo – 2 
• Proof of Payment of Premium Contribution

4. Midwives

a. Initial accreditation:

•  Provider Data Record for professionals 
• Performance Commitment 
• PRC license or its alternative 
• 1 x 1 photo – 2 pieces 
• Proof of Payment of Premium Contribution
• Any of the following evidences of Competency on the Expanded Functions of Midwives (not required for graduates from school year 1995 and onwards): 
• Certificate of Training from a program accredited by the Continuing Professional Education (CPE) Council of the Board of Midwifery of the Professional Regulation Commission (PRC) or 
• Training Certificate from DOH-recognized training program, or 
• Certificate of Apprenticeship for one or more years with a PHIC accredited Obstetrician-Gynecologist or an accredited midwife done in an accredited facility 
• MOA with any of the following as referral for complicated OB and Pediatric cases: 
• Accredited partner physicians (OB and Pedia) 
• Interlocal Health Zone (ILHZ) which allows sharing of human resource 
• DOH-certified BEmONC-CEmONC network

b. For continuous accreditation and re-accreditation due to gap:

• Provider Data Record for professionals 
• Performance Commitment 
• PRC license or its alternative 
• 1 x 1 photo – 2 pieces 
• Proof of Payment of Premium Contribution
• MOA with any of the following as referral for complicated OB and Pediatric cases: 
• Accredited partner physicians (OB and Pedia) 
• Interlocal Health Zone (ILHZ) which allows sharing of human resource 
• DOH-certified BEmONC-CEmONC network

5. Dentists

a. Initial accreditation:

• Provider Data Record for professionals 
• Performance Commitment 
• Updated PRC license or its alternative 
• 1 x 1 photo – 2 
• Proof of Payment of Premium Contribution

b. For continuous accreditation and re-accreditation due to gap:

• Provider Data Record for professionals
• Performance Commitment
• Updated PRC license or its alternative
• 1 x 1 photo – 2
• Proof of Payment of Premium Contribution

Source: www.philhealth.gov.ph