What are the maximum care timeframes?
They are the limits, in business days, that a Brazilian health plan has to make sure a member is seen after requesting a consultation, test, therapy, surgery or hospital stay. They are set in Normative Resolution (Resolução Normativa, RN) 566/2022 of ANS, Brazil's National Agency for Supplementary Health (the private health plan regulator). The rule has applied since February 1, 2023, and revoked RNs 259/2011 and 268/2011 [2]. In US terms, the closest concept is a timely access standard for network adequacy.
According to ANS, three rules define the scope of the deadlines [1]:
- they apply once the contract's waiting periods (carências) are over;
- they apply within the plan's coverage: coverage type, geographic coverage area and the product's service area [2];
- they apply to any qualified in-network provider, not to the doctor or hospital the member prefers.
The Prior authorization pillar guide shows where these deadlines fit in the authorization workflow.
The full RN 566/2022 table
Article 3 of RN 566/2022 has 17 items. The table follows the order of the rule, with deadlines checked against the ANS page updated on October 14, 2026 [1][2]:
| Item | Care | Maximum deadline |
|---|---|---|
| I | Primary care consultation: pediatrics, internal medicine, general surgery, gynecology and obstetrics | 7 business days |
| II | Consultation in other medical specialties | 14 business days |
| III | Consultation or session with a speech therapist | 10 business days |
| IV | Consultation or session with a nutritionist | 10 business days |
| V | Consultation or session with a psychologist | 10 business days |
| VI | Consultation or session with an occupational therapist | 10 business days |
| VII | Consultation or session with a physical therapist | 10 business days |
| VIII | Consultation or session with an obstetric nurse or midwife | 10 business days |
| IX | Consultation and procedures in a dentist's office or clinic | 7 business days |
| X | Clinical laboratory testing, outpatient | 3 business days |
| XI | Other diagnostic and therapy services, outpatient | 10 business days |
| XII | High-complexity procedures (procedimentos de alta complexidade, PAC) | 21 business days |
| XIII | Elective admission | 21 business days |
| XIV | Day hospital | 10 business days |
| XV | Oral cancer drugs for home use, including drugs for side effects and adjuvants | 10 business days, with supply split by cycle |
| XVI | Outpatient and oral home cancer drugs, radiation therapy and blood therapy tied to continuing care after a hospital stay | 10 business days, with supply split by cycle |
| XVII | Urgent and emergency care | Immediate |
Three rules in the same article change how the table reads [2]:
- High complexity overrides the category. Lab tests, other diagnostic and therapy services and day-hospital care classified as PAC in the Rol (the ANS list of mandatory coverage) follow the 21-business-day deadline. The rule is in § 5, as corrected by the February 2023 rectification notice.
- Contraception. Any method must be made available within the table deadlines and within 30 calendar days at most (§ 6, added by RN 595/2023, in force since January 1, 2024) [5].
- Follow-up visits. The timing is up to the treating professional [1].
The tables in the Prior authorization and The ANS rules that affect hospitals guides show only the items hospitals use most; this is the full version.
How are the deadlines counted?
The RN 566/2022 deadline runs from the date of the request until care is actually delivered (art. 3, § 1) [2]. Authorizing the procedure or putting the patient on a waiting list is not enough.
ANS clarifies that under RN 566/2022 the count includes the day of the request, while RN 623/2024 deadlines start on the next business day (FAQ, item 18) [4].
Illustrative example. An elective admission requested on a Monday, with no holidays in the period:
- the health plan's response (RN 623/2024, 10 business days starting Tuesday) is due by Monday of the third week;
- the admission (RN 566/2022, 21 business days counting that Monday) must happen by Monday of the fifth week.
The response can take almost half of the total deadline. That is why RN 566/2022 requires any needed authorization to be handled so that the deadlines can be met (art. 11) [2].
The care deadline and the response deadline are different things
Two clocks run at the same time. RN 566/2022 measures when care happens. RN 623/2024, in force since July 1, 2025, measures when the health plan answers the member's request [3][4]:
| Request | Response deadline (RN 623/2024, art. 12) | Care deadline (RN 566/2022, art. 3) |
|---|---|---|
| Urgent and emergency care | Immediate | Immediate |
| General care request, not answered on the spot | Up to 5 business days | Per the table |
| High-complexity procedures (PAC) and elective admission | Up to 10 business days | 21 business days |
| Outpatient lab test | The shorter one: 3 business days (art. 12, § 1) | 3 business days |
| Non-care request | 7 business days (art. 11) | Not applicable |
According to ANS, RN 623/2024 does not change any RN 566/2022 deadline, and the RN 566 deadline “must always prevail” (FAQ, items 12 and 14) [4]. Generic answers such as “under review” are not accepted after the deadline (item 17), and a review by the plan's ombudsman office does not suspend RN 566 deadlines (item 19) [4]. The Authorization denials guide covers written denials and reviews.
Who must meet the deadlines?
The health plan, toward the member. The hospital is not the addressee of RN 566/2022: the obligation is to offer at least one qualified in-network provider in time, not to guarantee a slot on a specific schedule [1][2].
RN 623/2024 is also a member-facing rule. According to the ANS FAQ, it does not govern requests made by providers (item 8) [4]. Between hospital and health plan, the contract and RN 503/2022 apply; RN 503 requires the contract to identify what needs authorization, the routine and the response deadline [9].
The deadlines reach the hospital in three ways:
- Surgical schedule. Elective surgery falls within the 21 business days for elective admissions or PAC. A slow authorization pushes the date back and may lead the plan to send the patient to another provider.
- Leverage when chasing the authorization code. Article 11 of RN 566/2022 ties authorization to the care deadline [2]. The authorization team can record the request date and use it when following up.
- Referred patients. When the network falls short, the plan may turn to an out-of-network hospital (art. 4, § 1) [2].
What happens when the deadline is missed?
When no in-network provider is available in time, RN 566/2022 sets out a chain of obligations for the health plan. It depends on the case: unavailability (there is an in-network provider, but no slot in time) or nonexistence (there is no provider in the municipality) [2].
- Unavailability (art. 4). The plan arranges care with an out-of-network provider in the same municipality, or with any provider in neighboring municipalities.
- No provider exists (art. 5). With no provider in the municipality, the plan arranges care in neighboring municipalities or in the municipality's health region.
- Transport (arts. 4 § 2, 5 and 7 to 9). If there is no provider in those areas, the plan provides round-trip transport within the deadlines. The plan chooses the means of transport, compatible with the member's condition. Transport extends to a companion for members under 18, over 60, and people with disabilities or special needs.
- Urgent and emergency care (arts. 4 § 3 and 6). The same guarantees apply without prior authorization, subject to Resolutions 8 and 13/1998 of the Supplementary Health Council (CONSU).
- Reimbursement (art. 10). If the plan fails to comply with articles 4 to 6 and the member pays for care, the plan must reimburse in full within 30 days of the request, transport included. In plans with free choice of providers, contract limits apply.
For the record, the health plan must provide a protocol number (art. 12) [2]. In a complaint to ANS, if the member does not give the protocol number, the complaint's filing date counts [7].
Noncompliance exposes the plan to sanctions (art. 14). For repeated noncompliance that puts care at risk, ANS may suspend product sales and impose a special technical management regime (art. 15) [2]. ANS tracks the deadlines in its Care Guarantee Monitoring program, with quarterly results [6]. Among the penalties in RN 489/2022, failing to guarantee members the access or coverage required by law carries a BRL 80,000 fine (art. 101) [8]. ANS decides how each case is classified.
When the hospital is the out-of-network provider
If the health plan refers a member to a non-contracted hospital to meet the deadline, the plan pays the provider “by agreement between the parties” (art. 4, § 1) [2].
The rule sets no price, fee schedule or payment term for that agreement. Without a contract, what was agreed beforehand is what applies. Practical safeguards:
| Situation | Risk to the claim | How to protect it |
|---|---|---|
| Health plan asks the hospital to treat an out-of-network patient | Claim with no agreed fee schedule or payment term | Written agreement before care: prices, reference fee schedule, required documents and payment term |
| Authorization given by phone | Denial (claim denial) for missing authorization code | Require the protocol number and authorization code on the TISS claim form |
| Patient pays and seeks reimbursement from the plan | Self-pay account, with risk of patient nonpayment | Treat as self-pay; provide a complete invoice and report for the art. 10 reimbursement |
TISS is the mandatory ANS standard for electronic data exchange between hospitals and health plans.
What to do when a patient's deadline is running out
The hospital supports the patient and documents everything, without taking over the health plan's role:
- Record the request date in the scheduling system and in the authorization request. The deadline runs from it.
- Follow up through the contract channel, citing the RN 566/2022 deadline and article 11.
- Advise the patient to get a protocol number from the plan and, if there is no solution in time, to file a complaint with ANS quoting that number [1][7]. That channel belongs to consumers; the NIP and ANS complaints guide explains the process.
- Use the provider channel when the plan's demands go beyond the contract or the rules: ANS runs a service to report irregular practices between health plans and providers [10].
What we see in operations
At Accrua, the deadline a hospital feels most day to day is the health plan's response to an authorization request, and Accrua OS tracks it automatically, request by request. Each request is logged with its sent date, response date and status, and the deadline in that health plan's contract sits next to the RN 623/2024 deadline.
In the hospital's history, we measure the time from an elective surgery request to the response, by health plan, and from demand to the procedure itself. That way the team knows which requests are close to running out and can act early, with the documents that health plan asks for that procedure.
When the hospital receives a patient referred by a health plan it has no contract with, we record where the referral came from and the authorization received before care is delivered. Without a contract, those records are what support billing later.
Where to start
- Make the request date a mandatory field in the authorization request and the surgical schedule.
- Build a deadline dashboard by type of care, with the RN 566/2022 and RN 623/2024 tables side by side.
- Review contracts to check that the agreed response time fits within ANS deadlines.
- Draft a template agreement for out-of-network care requested by health plans.
- Train the front desk to guide patients on protocol numbers and ANS complaints.