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Insurance commissioner launches digital health industry credentialing platform

Puerto Rico Insurance Commissioner Alexander Adams-Vega announced the launch of the new Digital Credentialing Platform for doctors and health professionals who provide services under private medical plans, as stipulated by Act 73 of 2023.

To implement the platform, the agency underwent a “thorough analysis” to identify solutions that make the credentialing processes more effective and efficient.

“The goal is to transform this process, which for years has been burdensome and bureaucratic, into one that is more agile and simple in terms of time and effort for the doctor and health professional,” agency officials said.

“This initiative seeks to streamline the credentialing processes for our doctors and health professionals and to ensure that credentialing is not a barrier to contracting with an insurer,” Adams-Vega said.

“The digital platform will make it easier for doctors and health professionals to complete their credentialing application and submit the required documents in one place to become a medical plan provider,” he added.

Before the platform’s launch, doctors and other providers, such as clinical laboratories and hospitals, had to validate their credentials with each insurer individually.

“The intent behind the centralized digital credentialing platform is to simplify and streamline a process that is crucial for a health system to function effectively, given that without health providers, there is no patient access to health services,” Adams-Vega noted.

The platform’s first phase of implementation is for doctors and health professionals who are either beginning their credentialing process or renewing their credentials in November.

Over the past two months, insurers, providers and billing service organizations, among others, have been briefed on the registration and operational processes so they can utilize the platform and initiate the credentialing processes, the agency said.

The law, signed in July, sets maximum timeframes for each insurer to complete the verification of an applicant doctor or health professional’s credentials from the date of a fully completed receipt by the health provider, including the necessary application and documents on the Uniform Application Form via the digital platform.

A process that previously took six months or longer, due to bureaucracy, might now be reduced to just 30 days.

“Every day that this process is unnecessarily delayed is an additional day it takes for a patient to receive health services,” Adams-Vega said. “We reaffirm once again our commitment to meet the needs of health professionals to prevent their departure from the island and maintain their services for the well-being of the people of Puerto Rico.”

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This story was written by our staff based on a press release.

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