Hospital billing What makes up a hospital claim?
Source: Anahp Observatory 2025, Table 3 · gross revenue by type, average for Anahp hospitals, 2024. Produced by Accrua.
See in the guide: Hospital billing: how the claim is built, submitted and paid without being deniedBrasíndice and Simpro Brasíndice and Simpro: what the contract with the payer needs to define
Sources: ANS — TISS Standard 202609; Law 9,656/1998, art. 17-A; CMED Resolution 3/2009; Simpro (10/17/2026) · the five decisions that set the price of a supply or drug on the claim. Produced by Accrua.
See in the guide: Brasíndice and Simpro: how to price supplies and drugs on the claimCBHPM CBHPM: the UCO and the operating cost of the procedure
How a CBHPM procedure value is built. Source: AMB, CBHPM value notice of Oct 18, 2025 (valid Oct 2025–Sep 2026); CBHPM 4th edition, General Instructions. Illustrative example. Produced by Accrua.
See in the guide: CBHPM table: what it is, how the tiers work and when it's usedInterim billing How do you close an interim claim, step by step?
A long stay billed in parts: each claim closes one period, with a cutoff date and time, and all claims reference the same admission request. Source: ANS — TUSS, table 55; TISS standard, Organizational Component 202609. Produced by Accrua.
See in the guide: Hospital interim billing: when and how to bill long inpatient staysClaim review and payment statements Payer payment statement: how do you reconcile claim by claim?
Source: ANS — TISS Organizational Component 202609 (items 33, 49, 55 and 56) and TUSS tables 27 and 38. The four routing destinations are an editorial grouping in this guide. Produced by Accrua.
See in the guide: Claim review and remittance statements: how to read and reconcile themHospital daily rates and fees How to bill daily rates and fees under TISS
From contract to claim: how daily rates, fees and gases reach the other expenses annex. Sources: Law 9,656/1998, art. 17-A; RN 503/2022; ANS, TISS standard 202609 (Organizational Component); TUSS tables 18 and 25. Produced by Accrua.
See in the guide: Hospital daily rates and fees: what can and can't be chargedBilling cath lab and high-cost procedures Five checks on a cath lab claim
The five checks on a cath lab claim before submission. Source: CFM Resolution 2.318/2022; ANS RN 566/2022, TISS standard 202609, TUSS tables 19 and 38. Produced by Accrua.
See in the guide: Cath lab and high-cost procedure billing: what to check before submitting the claimHow to bill OPME OPME billing has six steps
The six steps of OPME billing and the typical denial for each failure. Sources: ANS, TISS Standard, Organizational Component 202609; CFM Resolution 2,318/2022; ANS, TUSS table 38 (checked 10/17/2026).
See in the guide: How to bill OPME: authorization, invoice and traceabilityEmergency department vs. elective admission billing Emergency department vs. elective admission billing, side by side
The two billing flows: in an elective admission, authorization comes first; in the emergency department, care comes first and the payer is notified if the patient is admitted. The TISS standard does not say whether an ED visit followed by admission is billed as one claim or two. Source: ANS — TISS Standard 202609, RN 566/2022, TUSS table 23; Law 9,656/1998. Produced by Accrua.
See in the guide: Emergency department vs. elective admission billing: practical differencesTISS claim forms How TISS claim forms link to each other
Source: ANS, TISS standard — Organizational Component 202609 (September 2026), item 62 · how TISS claim forms link by number. Produced by Accrua.
See in the guide: TISS claim forms: SP/SADT, inpatient, physician fees and other expensesPhysician fees on the hospital claim How is each physician's fee calculated on the hospital claim?
Percentages: AMB — CBHPM, 2012 edition, General Instructions (items 2.1, 4.1, 4.2, 5.1, 5.2 and 6.2). Tables 35 and 61: TUSS/ANS. Illustrative example with hypothetical porte values; the contract edition and percentages prevail. Produced by Accrua.
See in the guide: Physician fees on the hospital claim: participation level and add-onsHospital bundles What is a hospital bundle (pacote)?
Source: Anahp — Balanço Observatório Anahp, 9th edition, March 2026, Tables 8 and 10 · share of bundled (pacote) payments in the medical expenses of Brazilian medical-hospital health plans (ANS open data processed by Arquitetos da Saúde). Produced by Accrua.
See in the guide: Hospital bundles: how to price and bill without losing marginThe TISS standard How the TISS standard works day to day
Source: ANS, TISS standard, Organizational Component, version 202609 (September 2026). Simplified flow of exchanges between hospital and health plan. Produced by Accrua.
See in the guide: The TISS standard: what it is, its components and how it worksClaim submission deadlines by payer Claim submission deadlines: how do you build a D-minus alert calendar?
Alert calendar counted back from the contract submission deadline (day D). Intervals are a suggestion and should be shortened for short deadlines. Source: Lei 9.656/1998, art. 17-A, § 2, II; ANS — TISS standard, Organizational Component 202609. Produced by Accrua.
See in the guide: Claim submission deadlines by payer: how to track them and never miss oneThe TUSS table How do you look up the official TUSS table?
Source: ANS, TISS Standard — Organizational Component 202609 (September 2026) · six steps to code a claim item with TUSS. Produced by Accrua.
See in the guide: The TUSS table: what it is, how to look up and use the codesTISS XML batches TISS XML batches: three validation layers before submission
Source: ANS — TISS standard, Organizational Component 202609 (items 47, 55, 134 and 148) and TUSS table 38 (message codes). The three layers are an editorial grouping of the rejection messages. Produced by Accrua.
See in the guide: TISS XML batches: submission errors and how to avoid rejection
