Puerto Rico Insurance Commissioner Suzette del Valle Lecároz announced Monday that the Office of the Insurance Commissioner (OCS) has opened an investigation into the procedures health insurance companies use to credential and contract healthcare providers, amid complaints from physicians about duplicate documentation requests, additional requirements and delays. The probe follows implementation of Act 73 of 2023, which streamlined and standardized credentialing and created the Online Credentialing System (SICRO), a centralized platform where providers submit a uniform application accessible to insurers.
Under the law, health plans must use the Uniform Credentialing Form, cannot demand information beyond it, must notify providers of deficiencies within 15 days, and must complete credential verification within 30 days of receiving a properly completed application. Del Valle Lecároz said contracting and network participation decisions remain internal to health plans and separate from credentialing, but insurers cannot use them to circumvent the law.
As part of the investigation, OCS will summon health insurers to review their practices, restate their obligations and require elimination of procedures that conflict with the statute. Insurers found in violation could face administrative fines of $500 to $10,000 per violation. The commissioner said a more efficient process could strengthen provider networks and improve patient access, and she urged providers facing problems to report them to OCS.