HB
Hospital Billing
Claims Administrator

Return Reasons Report

Why claims come back — which reasons drive Return to Hospital vs. Denial.

Reasons Tracked
7
₱ 194,850.50
0 returns still missing a reason
Most Common Reason
Discrepancies in data entries or patient information
₱ 55,152.50
4 claims
Highest Denial Share
Cases deemed non-compensable under PhilHealth rules
₱ 11,505.00
100% denied of its own claims
Highest RTH Share
Discrepancies in data entries or patient information
₱ 55,152.50
100% RTH of its own claims
Return Reason Breakdown
Share of RTH vs. Denied claims per reason
RTH
Denied
Discrepancies in data entries or patient information
4 claims · ₱ 55,152.50
Errors or schema bugs in Claim Form 4
4 claims · ₱ 30,400.50
Improperly accomplished Claim Form 2
3 claims · ₱ 57,037.50
Cases deemed non-compensable under PhilHealth rules
2 claims · ₱ 11,505.00
Non-compliance with the standard of care or internal system guidelines
1 claims · ₱ 29,250.00
Unavailable, incomplete, inconsistent, or unreadable supporting documents
1 claims · ₱ 5,752.50
Violations of specific policies such as the Single Period Confinement rule
1 claims · ₱ 5,752.50
Reason Share
Share of RTH, and of Denied, claims by reason
RTH Share
12
RTH
Discrepancies in data entries or patient information
33.3%
Errors or schema bugs in Claim Form 4
33.3%
Improperly accomplished Claim Form 2
25%
Unavailable, incomplete, inconsistent, or unreadable supporting documents
8.3%
Denied Share
4
Denied
Cases deemed non-compensable under PhilHealth rules
50%
Non-compliance with the standard of care or internal system guidelines
25%
Violations of specific policies such as the Single Period Confinement rule
25%
Watchlist
Reasons with the most money still on hold
1
Improperly accomplished Claim Form 2
3 claims
₱ 57,037.50
2
Discrepancies in data entries or patient information
4 claims
₱ 55,152.50
3
Errors or schema bugs in Claim Form 4
4 claims
₱ 30,400.50
4
Non-compliance with the standard of care or internal system guidelines
1 claims
₱ 29,250.00
5
Cases deemed non-compensable under PhilHealth rules
2 claims
₱ 11,505.00
Reason Total Distribution RTH Rate Denial Rate Amount on Hold
Discrepancies in data entries or patient information 4
100% 0% ₱ 55,152.50
Errors or schema bugs in Claim Form 4 4
100% 0% ₱ 30,400.50
Improperly accomplished Claim Form 2 3
100% 0% ₱ 57,037.50
Cases deemed non-compensable under PhilHealth rules 2
0% 100% ₱ 11,505.00
Non-compliance with the standard of care or internal system guidelines 1
0% 100% ₱ 29,250.00
Unavailable, incomplete, inconsistent, or unreadable supporting documents 1
100% 0% ₱ 5,752.50
Violations of specific policies such as the Single Period Confinement rule 1
0% 100% ₱ 5,752.50
Showing 7 of 7 reasons