Hospital Services Assessment, Health Insurance Credentialing Criteria, and Hospital Accreditation Roadmap for Iraq
BACKGROUND & OBJECTIVE
The Ministry of Health and the National Insurance Authority in Iraq sought a comprehensive assessment of hospital services, a health insurancecredentialing framework, and an accreditation roadmap for hospitals. The initiative aimed to evaluate public and private healthcare services, examinebilling and coding standards, and develop recommendations for licensing and accreditation. The primary objective was to establish a structured healthinsurance pilot program, ensuring a transparent, efficient, and internationally aligned healthcare system in Iraq.
PROJECT APPROACH
The project was structured into the following key areas:
- Hospital Services Assessment – Conducted a detailed inventory of services, medications, and consumables across Iraqi hospitals, categorizing them bypublic/private status, department, and cost.
- Health Information Management Systems (HMIS) Analysis – Evaluated accounting and coding standards (CPT, HCPCS) and their relevance to Iraqihealthcare, ensuring accurate billing and reimbursement processes.
- Credentialing Framework Development – Defined minimum criteria for hospital and healthcare professional credentialing, ensuring compliance withglobal best practices.
- Hospital Accreditation Strategy – Proposed a phased approach to hospital accreditation, incorporating global models and regulatory compliancerequirements.
- Capacity Building & Implementation Readiness – Developed workshop materials to enhance hospital billing system competencies among healthcareprofessionals.
OUR METHODOLOGY
The project was executed using a data-driven, consultative approach:
- Primary Research & Field Visits – Collected real-world hospital data, including billing practices, licensing procedures, and accreditation readiness.
- Hospital Service Mapping & Evaluation Matrix – Created classification models to match pricing structures, charge categories, and service offerings.
- Business Requirements Documentation – Established clear regulatory and operational guidelines for licensing and credentialing.
- International Benchmarking & Desk Research – Assessed global best practices for hospital accreditation and health insurance frameworks.
THE RESULTS
The engagement successfully delivered:
- A complete database of 1,548 hospital services across public and private hospitals, categorized into nine charge groups aligned with internationalstandards.
- A defined health insurance credentialing process, including licensing procedures for hospitals and minimum requirements for empanelment.
- A standardized classification structure, ensuring a unique, non-overlapping pricing system for hospital services.
- A national accreditation roadmap, outlining phased implementation and best practice adoption for hospitals in Iraq.
