What is the deadline to appeal a denial?
The deadline to appeal a denial is whatever the contract between the hospital and each health plan (operadora) says. Neither Law 9,656/1998 nor RN 503/2022, a normative resolution of the National Agency for Supplementary Health (Agência Nacional de Saúde Suplementar, ANS), sets a number of days to contest a denial [1][2].
RN 503/2022 governs written contracts between health plans and providers. Art. 14 requires the contract to describe the administrative and clinical audit routine, the cases that can lead to a denial and three deadlines: for the provider to appeal, for the health plan to respond, and for the health plan to pay once the denial is reversed [1]. A denial is the full or partial refusal to pay items on a claim; the overview is in the guide Hospital claim denials.
So the deadline varies from one health plan to another.
The five deadlines the rule requires in the contract
The law and RN 503 require five payment-related deadlines in the contract, none with a number of days [1][2].
View the timeline as a table
| Between | Deadline | Where it is required | Days in the rule |
|---|---|---|---|
| Claim submitted → statement | Payment | Law 9,656/1998, art. 17-A, § 2, II; RN 503, art. 13 | None set |
| Statement → appeal logged | Appeal (X days) | RN 503, art. 14, II | None set |
| Appeal → health plan response | Response (same X days) | RN 503, art. 14, sole paragraph | None set; equal to the appeal deadline |
| Response → reversed amount paid | Post-reversal payment | RN 503, art. 14, II | None set |
| Deadline | Where it is required | Does the rule set days? | What the contract must state |
|---|---|---|---|
| Claim submission (billing) | Law 9,656/1998, art. 17-A, § 2, II; RN 503, art. 13 | No | Deadline and method for each type of claim |
| Claim payment | Law 9,656/1998, art. 17-A, § 2, II; RN 503, art. 13 | No | Payment deadline and when the count starts |
| Denial appeal | RN 503, art. 14, II | No | Days for the hospital to appeal and the start date |
| Health plan response | RN 503, art. 14, II and sole paragraph | No, but it must equal the appeal deadline | The same number of days given to the hospital |
| Payment after reversal | RN 503, art. 14, II | No | Deadline to pay the reversed amount |
The deadlines to answer authorization requests (art. 15) and to give notice of termination (art. 16) have no number either [1]. The only deadline in days, in article 17-A of the law and in RN 503, is for negotiating the annual adjustment: 90 days from the start of the year (Law 9,656/1998, art. 17-A, § 3; RN 503, art. 12, § 3) [1][2].
A clause-by-clause review of the rest of the contract is in the guide RN 503/2022: what the payer contract must say.
How does parity between appeal and response work?
Parity means the hospital and the health plan get the same number of days: one to appeal, the other to respond to the appeal (art. 14, sole paragraph) [1]. If the contract gives the hospital 30 days, the health plan has 30 days to respond (illustrative example).
With 15 days for the hospital and 60 for the health plan, the contract is out of line with the rule (illustrative example).
The rule does not say when each deadline starts or whether days are calendar or business days. These points are left to the contract:
- Appeal start date: for example, the date the claim review statement is made available. It lists the denied items for each claim form [4].
- Response start date: the appeal's protocol date. In the TISS standard (Troca de Informação de Saúde Suplementar, Brazil's mandatory health plan data exchange standard), receipt of an appeal generates a protocol number that proves delivery [4].
- Day count: calendar or business days, the same for both parties.
- Start date for payment after reversal: the date of the response that accepts the appeal.
The step-by-step submission is in the guide Denial appeals.
Rule, TISS code and market practice: what is what
Different sources talk about the deadline, with different weight. Only the first is a regulatory requirement.
| Source | What it says about the deadline | Weight for the hospital |
|---|---|---|
| Law 9,656/1998 and RN 503/2022 | The contract must set the deadlines; appeal equals response | Mandatory; noncompliance exposes the health plan to ANS sanctions (RN 503, art. 21) [1] |
| TUSS table 38 | Codes to report a denial for a missed deadline | Standardizes the message; does not create or change a deadline |
| Each contract's clause | The number of days and how they are counted | The deadline that applies to that health plan |
| “Market” ranges (30, 60, 90 days) | Figures repeated in industry content | No regulatory basis; they do not replace the contract |
Deadline codes in table 38. Table 38 of TUSS (Terminologia Unificada da Saúde Suplementar, the unified terminology for Brazilian health plans) lists the messages used to justify a denial. On the official ANS database, on October 17, 2026 [3]:
- 2909, “deadline for requesting a denial appeal has expired”: in effect since 04/01/2013.
- 2907, “180-day deadline for requesting a review exceeded”: not in TUSS version 202607 (official ANS spreadsheet); in the online lookup it shows no effective, implementation or end dates. The number 180 appears only in the code's name.
- 3214, “claim billed after the deadline set in the provider contract”: in effect since 12/01/2025, with implementation by 06/30/2026. It refers to claim submission.
The “180 days” in a code's name is not a rule: the contract deadline applies. The other codes are in the guide TISS denial codes.
Rules cited by mistake. The appeal deadline is sometimes attributed to RN 395/2016, which was replaced by RN 623/2024. That rule covers requests from plan members, and ANS states that it does not govern requests from providers [5].
What Anahp says. The 2025 contracting manual of the National Association of Private Hospitals (Associação Nacional de Hospitais Privados, Anahp) for hospitals and health plans notes that ANS sets no payment deadlines and suggests considering automatic extension of billing deadlines when systems are unstable [7]. It is a recommendation, not a regulatory requirement.
What if the contract sets no deadline?
A contract without the denial deadlines does not comply with RN 503, and the party answerable to ANS is the health plan (art. 21) [1]. The gap, however, gives the hospital no automatic number of days: the rule has no default deadline.
The Anahp manual suggests escalating disagreements in stages: a meeting, written notice and an out-of-court notice with a deadline for the response [7]. Three steps reduce the risk:
- Record the gap in writing to the health plan and request an amendment with the three denial deadlines and parity.
- Appeal early, without waiting for a definition, and keep the TISS protocol for every appeal.
- Submit claims in the current TISS version. RN 503 forbids the health plan from blocking appeals or access to denial justifications, but only when billing follows that standard (art. 5, V and VI, and sole paragraph) [1].
Collecting late payments is covered in the Late payment by health plans guide.
How to track deadlines by health plan
Different deadlines in each contract call for a single tracking table, reviewed at each renewal. The template below uses the rule's five deadlines and the start dates.
| Field | Health plan A (illustrative example) | Health plan B | Health plan C |
|---|---|---|---|
| Contract clause and version | Clause 9, 2025 amendment | ||
| Claim submission deadline | 30 days from discharge | ||
| Payment deadline | 30 days from claim protocol | ||
| Denial appeal deadline | 60 calendar days | ||
| Appeal start date | Statement made available | ||
| Health plan response deadline | 60 calendar days (parity) | ||
| Payment after reversal | Next payment cycle | ||
| Parity respected? | Yes | ||
| Appeals rejected for deadline (code 2909) this month | 0 |
Values in the “Health plan A” column are illustrative.
Three routines make the table useful:
- Due-date alert. Each denial gets its appeal deadline when the statement is imported.
- Response alert. Each logged appeal gets the health plan's response deadline; once it passes, the hospital sends the status request provided in TISS [4] and records the delay.
- Missed-deadline indicator. Appeals rejected with code 2909, by health plan, show the denial lost only because of the deadline.
To compare health plans, the ANS Denial Indicators Dashboard (Painel de Indicadores de Glosa) shows each plan's average payment time, in days between the claim protocol and the last payment of each closed claim form [8]. The cash effect of delays is in the guide Hospital average collection period.
What may change with Public Consultation 170/2026
ANS Public Consultation 170/2026 discussed a rule that would replace RN 503, with input accepted until July 3, 2026. As of October 17, 2026, the final text had not been published [9].
The draft proposes paying the undisputed part of a partially denied claim without waiting for the appeal review [9]. It is not yet known whether the final text will keep parity between appeal and response. Until publication, RN 503/2022 and each contract's deadlines apply.
What we see in operations
At Accrua, the deadlines in each contract are loaded into Accrua OS alongside the price table, the authorization rule and that health plan's denial history. That is what makes it possible to track what RN 503/2022 leaves to the parties: the deadline to contest, the deadline for the health plan to respond and the deadline to pay after a reversal.
Agents track the deadline and status of each denial and draft the appeal with the evidence the health plan asks for, leaving time for a person to review it. Dropping an appeal or accepting a denial is never automatic: a biller or auditor decides, with everything consolidated and the source in view.
When we review a hospital's contracts, we check whether all three deadlines are written down and whether the time to contest matches the health plan's time to respond. A contract with no deadline or uneven deadlines becomes a negotiation item. A denial rejected because the appeal window expired, code 2909, is treated as a process failure to fix.
Where to start
- Collect the deadline clause from each active contract and amendment.
- Build the tracking table with the five deadlines, start dates and day count for each health plan.
- Flag gaps and unequal deadlines and take them to the next renewal or price negotiation.
- Set alerts for appeal and response deadlines based on the statement date and the TISS protocol.
- Review monthly the appeals rejected for missed deadlines (code 2909) and the actual payment time after reversal, by health plan.