SISALRIL implements new medical auditing regulations in Dominican Republic

The Superintendency of Health and Labor Risks (SISALRIL) has implemented new medical auditing regulations in the Dominican Republic. Formalized through Circular SSRL-INT-2026-002960, the measure establishes criteria and standards to evaluate healthcare processes and ensure compliance within the Family Health Insurance (SFS) and Labor Risk Insurance (SRL).

The regulation aims to increase transparency and manage payments, objections, and disputes between Health Risk Administrators (ARS), the Dominican Institute for the Prevention and Protection of Labor Risks (IDOPPRIL), and Health Service Providers (PSS). By regulating audit types, timelines, and arbitration mechanisms, the initiative seeks to reduce out-of-pocket healthcare expenses for the insured population.

As part of this rollout, SISALRIL has launched a Medical Auditor Registry via its virtual office. This technological tool will validate and issue official codes for medical auditors to ensure professional suitability within the Dominican Social Security System (SDSS). Additionally, the implementation of the Scheme 0039 for Medical Audit Monitoring will provide data to track results and improve the management of payments and medical glosas.