What is an expired authorization code?
An expired authorization code is a prior authorization whose expiry date passed before the procedure, test, session or admission took place. In Brazil the code is called senha de autorização (authorization number). It still exists in the health plan’s system, but it no longer covers care delivered after that date.
The code is the number the health plan (operadora, the Brazilian health insurer regulated by the National Supplementary Health Agency, ANS) issues when it approves a request. The hospital reports it on the claim form, and the health plan checks during claim review whether the item was authorized and within the deadline. The broader process is covered in the Prior authorization guide.
That is why validity is a revenue control, not a front-desk detail. A correct code, for the right patient and the right procedure code, still leads to a denial if care happens one day after expiry.
Who sets the validity of the code
The health plan sets the validity, in its contract with the hospital or in the operating manual that the contract adopts. No resolution of the National Supplementary Health Agency (Agência Nacional de Saúde Suplementar, ANS) establishes a standard period, such as 30 or 60 days, for all health plans.
What regulation does require is that this point be written down. Law 9,656/1998 lists, among the mandatory clauses of the provider contract, the identification of acts that depend on the health plan’s authorization [2]. RN 503/2022 (ANS Normative Resolution 503) goes further: the contract must identify what requires administrative authorization and set the operating routine, each party’s responsibility and the response deadline, with any denial justified under the TISS standard [3]. The RN 503 payer contract guide covers the other clauses.
In practice, each health plan has its own rule. Manuals often differ on the period, the start date (authorization or issue date), whether revalidation is allowed and how many times. That is why validity belongs in each health plan’s rule map, together with what requires a code and the request channel.
Where validity appears on the form. The ANS TISS standard (Troca de Informações na Saúde Suplementar, the mandatory data exchange standard) includes, in the authorization data of the SP/SADT form (professional services and diagnostic and therapeutic services), fields for authorization date, authorization number and authorization expiry date [4]. The health plan’s response must list every item requested, including those not authorized [7]. See the message structure in the TISS standard guide.
Why does the code expire before the procedure?
The code expires because validity runs from the authorization date, while the date of care depends on scheduling, the patient and clinical progress. When those dates drift apart, expiry happens even when the authorization process was done right.
| Cause | How it happens | How to prevent it |
|---|---|---|
| Distant scheduling | The elective procedure is booked after the validity ends | Check validity at scheduling, not at billing |
| Rescheduling | Patient, physician or operating room moves the date | Recheck the code at every reschedule, with an automatic alert |
| Slow response | The health plan takes days to respond and the usable window shrinks | Request early enough for the contractual response deadline |
| Longer stay | Authorized days run out before discharge | Request the extension before the authorized days end |
| Serial therapy | The patient misses sessions and the rest fall after expiry | Track remaining sessions and validity together |
| Pending documents | The code is issued, but care waits for a report, test or implant (OPME) | Check documents and materials before requesting the code |
| Outdated records | Validity was not recorded in the hospital’s system | Record code, expiry and authorized items as soon as the response arrives |
Slow responses deserve attention. When the beneficiary makes the request, RN 623/2024 gives the health plan up to 5 business days to respond, or 10 business days for high-complexity procedures and elective admissions, counted from the next business day [5]. The response cannot exceed the guaranteed access deadlines of RN 566/2022, which are 21 business days for both cases [5][6].
ANS clarifies, however, that RN 623/2024 does not govern requests made by providers [5]. Between hospital and health plan, the contractual response deadline required by RN 503/2022 applies [3]. Scheduling therefore needs to add the contractual response time and each health plan’s validity period.
What happens when the procedure is done with an expired code
When care happens after expiry, the health plan is likely to deny the item during claim review. Table 38 of TUSS (Terminologia Unificada da Saúde Suplementar, the standard terminology, which includes denial and rejection messages) has a specific code for this: 1414, “data de validade da senha expirada” (authorization code expired) [1]. The same table is used in authorization and billing responses [7].
It is an administrative denial: it does not question the clinical indication, only the deadline. That makes it largely preventable through internal process, and hard to reverse when there is no record of what happened. Other codes are listed in the TISS denial codes guide.
An appeal is stronger when the hospital can show it acted on time. Useful evidence includes:
- the protocol number of a revalidation or extension request made before expiry;
- the date the health plan responded, when a late response shortened the usable validity;
- the urgent care record, when care could not wait for a new code;
- the physician’s progress notes justifying the stay, for inpatient cases.
Argument templates are in the Denial appeal guide.
How do you track code validity by health plan?
Tracking starts with each health plan’s rule map and ends with a daily queue of codes about to expire. The goal is that no code expires without someone deciding: deliver care earlier, revalidate or request again.
View text description
- Record: authorization number, authorization date, expiry date and authorized items.
- Match: expiry date compared with the scheduled date.
- Alert: queue of codes about to expire.
- Decision before expiry: move the service up, revalidate (if the health plan allows) or file a new request or stay extension.
- Pre-billing check: date of each item against code expiry. With no decision, the code expires and tends to become denial 1414 (authorization code expired).
- Record. When the response arrives, the authorization center records the code, authorization date, expiry date and authorized items in the hospital’s system.
- Match. The system compares the expiry date with the scheduled date of care.
- Early alert. Codes that expire before care, or within the next few days, go into a work queue.
- Decision. The team moves care up, requests revalidation or files a new request, according to the health plan’s rule.
- Pre-billing check. Billing checks the date of each item against the expiry date before closing the claim form.
The rule map needs the information below for each health plan, taken from the contract and the provider manual.
| Rule map item | Why it matters |
|---|---|
| Validity by authorization type (test, procedure, admission, therapy, OPME) | Periods may differ within the same health plan |
| Start date (authorization or issue date) | Changes the last valid day for care |
| Revalidation allowed, channel and limit | Defines whether to revalidate or request again |
| Contractual response deadline | Defines how far ahead the request must go out |
| Rule for linked codes (admission plus OPME, chemotherapy or radiotherapy attachments) | Revalidating only one code may leave the other expired |
| Urgent care and later regularization rule | Avoids denial of care that started without a code |
Two indicators show whether tracking works: amount denied for expired codes over amount billed, by health plan, and the number of codes that expired with no recorded decision. Authorization indicator formulas are in the Prior authorization pillar.
What to do when the code expires
The path depends on timing: before care, the situation can still be fixed; after care, only an appeal remains.
Before care. If the health plan allows it, request revalidation through the designated channel and record the protocol. If it does not, or the limit has been used, file a new request, which may be reviewed as a new case and require updated documents. If the health plan denies it, see the Authorization denial guide.
Inpatient stays. The admission code covers a number of days. Continuing depends on an extension request, which in the TISS standard is linked to the initial admission request [7]. It should go out before the authorized days end, with the clinical justification: days billed without an extension can be denied under code 1917, “falta prorrogação para quantidade de diárias cobradas” (no extension for the number of days billed) [1]. Step by step in the Inpatient stay extension guide.
Urgent and emergency care. Care does not wait for a new code: Law 9,656/1998 requires coverage of these cases, with a maximum waiting period of 24 hours [2]. The hospital notifies the health plan following the contract routine and regularizes the authorization as soon as possible.
After care. If the item was delivered with an expired code, gather the evidence before submitting the claim: protocol numbers, response dates and clinical records. When there is a basis, appeal the 1414 denial with those documents. When there is not, record the loss and its cause to fix the process.
What we see in operations
At Accrua, authorization validity is tracked by health plan, because each contract or provider manual sets its own period. Each health plan's authorization rules are loaded into Accrua OS, and agents track the validity of every open authorization code against the scheduled date of the procedure.
When a rescheduled case, a series of therapy sessions or a stay that runs long pushes care past the validity date, the system flags it ahead of time, while there is still room to request a new code or an extension. For inpatient stays, tracking the authorized days is how the extension request goes out before the period ends, avoiding denial code 1917.
Before submission, the claim is checked against the authorization number, the authorization date and the validity. If the item was performed with an expired code, the decision to appeal, with the justification and the request history, or to accept denial 1414 stays with a person. The cause of the expiry goes back to scheduling as a change in routine.
Where to start
- Collect the validity rule of each health plan from the contract and provider manual, by authorization type.
- Record the expiry date of every code in the hospital’s system when the response arrives.
- Build a daily queue of codes that expire before scheduled care.
- Measure denial 1414 over the last 12 months, by health plan and cause.
- Add validity to the pre-submission check of each claim form.