The challenge
The group operated several medical centres serving residents with a wide mix of insurance plans. Some branches were listed with payers that others were not, and some were placed on network tiers that did not reflect the services they offered. Patients were turned away or redirected because their card was not accepted at the branch closest to them.
Previous empanelment attempts had been handled branch by branch, with different documents, inconsistent service lists and little follow-up. Applications stalled without a clear reason, and management had no single view of where each branch stood with each payer. The group also needed to be sure that new network access would lead to claims that were actually paid.
Our approach
Payer landscape review
We mapped the insurers, networks and plans most relevant to the group's catchment and employer base, including the Thiqa and Daman programmes, and compared that list with each branch's current listings and tiers.
Consistent empanelment files
We built one standard set of facility, licensing, practitioner and service documentation, adapted for each branch, so that every application reached payers complete, accurate and consistent with DoH Abu Dhabi records.
Structured payer follow-up
We tracked every application in a single register, followed up with insurers and administrators on a fixed rhythm, and prepared the group's team for tariff and contract discussions.
Billing readiness for new networks
Before new networks went live, we aligned registration, authorisation and Shafafiya submission routines with each payer's rules, so the first claims under new contracts were submitted correctly.
The outcome
The group now has a clear, current picture of its network position across all branches, and a wider set of payer relationships that better matches the patients in its catchment. Branches present themselves to insurers consistently, and management knows exactly which applications are open and what each one is waiting for.
Because billing was prepared alongside empanelment, new network access has translated into claims that are accepted rather than rejected on technicalities. The group's team now maintains the payer register and documentation themselves, which makes future applications and renewals considerably easier to manage.