Why are our reimbursement cycles taking 90+ days in the UAE?

UAE reimbursement delays above 90 days typically stem from three sources: incomplete clinical documentation triggering insurer queries (42%), coding discrepancies between DHA/DoH coding standards and insurer expectations (31%), and batch submission timing misalignment with insurer processing windows (27%).

The documentation delay mechanism is the most impactful and most fixable. UAE insurers require clinical justification for procedures above specific cost thresholds — the threshold varies by insurer and by plan tier, typically AED 3,000–8,000 per episode for outpatient and AED 15,000+ for inpatient. When claims are submitted without the supporting clinical narrative — operation notes, discharge summaries, radiology reports, diagnostic results — the insurer raises a query. The claim enters manual review, adding 30–45 calendar days before adjudication can proceed. A single missing document on a complex claim can reset the entire adjudication clock.

Coding discrepancies in the UAE are structurally different from other markets. DHA uses ICD-10-CM and CPT with UAE-specific modifications and fee schedule interpretations. Individual insurers have layered their own bundling rules and code edit logic on top of the DHA framework — and these insurer-specific rules are not publicly documented. A coding team that follows DHA guidelines precisely can still generate denials from a specific insurer that applies different bundling interpretations for combinations of procedure codes in high-value specialties.

Batch timing misalignment is less understood but structurally significant. Most UAE hospitals submit claims in weekly batches to reduce administrative overhead. Major UAE insurers process claims in cycles of 7–14 days aligned to their internal calendar. A claim submitted on day 1 of an insurer’s 10-day processing cycle begins adjudication immediately; a claim submitted on day 9 waits 10 days before entering the same queue. Over a year, this timing variance adds an average of 8–12 days to cycle time for no clinical reason.

Standard UAE revenue cycle dashboards show total AR aging — the amount outstanding in 30, 60, 90, 120+ day buckets — by insurer. This view is useful for cash flow management but reveals nothing about the cause of the aging. Two insurers may both show 35% of receivables in the 90+ day bucket, but one is there because of systemic documentation failures requiring clinical improvement programs, while the other is there because of structural adjudication practices that require contract renegotiation. The action required is completely different, and AR aging alone cannot distinguish between them.

Query rate by insurer is the diagnostic metric that separates documentation failures from adjudication practices. An insurer with a 45% query rate on your claims is either applying unusually aggressive review standards or your documentation for that insurer’s patient population is systematically below threshold. Both hypotheses require different interventions, and both are invisible in AR aging data.

Payer-specific query analysis is the foundational diagnostic. For each insurer, track: query rate (queries raised per 100 claims), query reason category (missing documentation, coding amendment, medical necessity, duplicate), average resolution time by query category, and approval rate after query resolution versus direct adjudication. This breakdown reveals which payers have structural adjudication problems — query rates above 30% regardless of documentation quality — versus documentation failures that the clinical team can address.

A clinical documentation improvement (CDI) program targeting high-value procedures is the highest-ROI intervention for documentation-driven delays. The program identifies the top 15–20 procedure codes by revenue that frequently trigger queries, defines the minimum documentation package required for each, and builds pre-submission checklists into the discharge workflow. CDI programs in UAE hospitals typically reduce documentation-related query rates by 35–50% within 6 months.

Switching from weekly batch submission to daily electronic claims submission eliminates the timing variance delay. Daily submission costs marginally more in administrative overhead but recovers 8–12 days of average cycle time across all insurers. For a hospital with AED 80M in annual insurance revenue, 10 fewer days in receivables translates to approximately AED 2.2M in working capital improvement at typical healthcare financing rates.