Providers Contracting Process Improvements

Abstract

The project of Contracting process improvements was carried out in one of the most recognized companies in Puerto Rico of the Health insurance industry. Currently the Provider’s Contracting process does not meet the time established by the regulators and the established politics. The Contracting process involves several sub processes, such as Credentials, Site visit, Configuration, and Validation. The main causes that affect the time of the Contracting Process are that there is no standardized process, no established TAT’s to manage petitions, areas don’t have target or goals established, lack of knowledge of the personnel, no metrics for efficiency or productivity, roles are not clear. The process was studied “End to End” with the purpose of identifying the causes of noncompliance and implementing improvements that help meet the objectives and goals of the company. Key Terms ⎯ Credentialing, maintenance, selection criteria, specialization.