Modelado de requerimientos para la automatización de autorizaciones administrativas del sistema de salud

Abstract

Automating the administrative authorization process within Health Promoting Entities (HPEs) offers an opportunity to enhance the efficiency, timeliness, and quality of healthcare service delivery. Although current regulations mandate that authorization management take place directly between the provider and the payer without shifting the administrative burden onto the user delays persist in practice due to information fragmentation, multiple required validations, and a lack of system integration. These limitations lead to redundant processing, longer response times, and disruptions in the continuity of care. In this context, defining a requirements model for automation using artificial intelligence agents presents a viable alternative for optimizing request management, strengthening decisión making, and ensuring regulatory compliance. Structuring functional requirements, business rules, and system behavior models provides a solid foundation for developing technological solutions aligned with international requirements engineering standards. Consequently, this proposal fosters more agile, transparent, and reliable processes, helping to reduce operational workloads, minimize errors, and improve the experience for both users and the administrative staff managing the health system