BPM as a tool for analysis and redesign of High Complexity Procedures authorization process in health plans companies

Abstract

Healthcare in Brazil is a delicate matter, especially in regulatory issues. Notorious is the cases of law non-compliance, the healthcare operators are notorious violators of these same laws. The purpose of this paper is to analyze and describe a process relevant in healthcare operators, prior authorizations of high complexity services. So, therefore, in their components can be identified the bottlenecks, in order to understand its functioning and carry out an efficiency analysis, based on a reference framework notation model. We conclude that with reshape of this process wemade changes that mainly eliminate the bureaucratic aspects of the process (keeping it correct by the law) and narrowed the channel of communication between the applicant and the query and analysis area in order to speed up the outcome of the requested authorizations, focusing more on the technical functions and not in administrative, decreasing the waiting times while improving the quality and accuracy of service.