TISS denial codes Where the TISS denial code shows up: the claim analysis statement
Source: ANS, TISS standard, Organizational Component, version 202609 (September 2026), items 49, 51, 55, 56 and 103. Simplified flow from claim batch to action on each denial code. Produced by Accrua.
See in the guide: TISS denial codes: what each message in table 38 meansDenial management Denial management: the six-step process, from the remittance to the root cause
Source: ANS — TISS standard, Organizational Component 202609 (items 33, 51, 55, 56) and RN 503/2022, art. 14 · six-step denial management flow. Produced by Accrua.
See in the guide: Denial management: process, owners and KPIsHospital daily rate and fee denials: causes, codes and prevention Why do daily rates and fees weigh so much on the claim?
Source: Anahp — Observatório Anahp 2025 (2024 data), Table 3 · gross revenue of Anahp hospitals by type, 119 reporting hospitals. Produced by Accrua.
See in the guide: Hospital daily rate and fee denials: causes, codes and preventionHome care denials Home care denials: how the proof trail works
Home care proof trail: the steps repeat for each authorized period. Source: ANS — RN 465/2021, art. 13, and Technical Opinion 05/2021; Anvisa — RDC 11/2006; Cofen — Resolution 464/2014; TUSS table 38. Produced by Accrua.
See in the guide: Home care denials: how to prove every visit, supply and piece of equipmentPhysician fee denials How the physician fee is calculated (and where denials start)
Source: AMB — CBHPM 2012, General Instructions; ANS — TUSS tables 35 and 38. The applicable CBHPM edition is the one set in the contract. Produced by Accrua.
See in the guide: Physician fee denials: team, surgical approach and add-onsInitial and final denials At Anahp hospitals, only a small share of initial denial becomes a loss
Source: Anahp, Observatório Anahp 2025 and Balanço Observatório Anahp, 9th edition (March 2026). Management initial denial as % of amounts receivable from health plans; accounting accepted denial as % of gross health plan revenue. Produced by Accrua.
See in the guide: Initial, final and accepted denials: what each one measuresSupplies and drug denials Supplies and drug denials: the code comes from TUSS; the price comes from the contract
Source: ANS — TUSS table 38 (version 202607); Law 9,656/1998, art. 17-A; CMED Resolution 3/2009 · from item used to claim value, with the typical denial at each step. Produced by Accrua.
See in the guide: Supplies and drug denials: the most common causes and how to prevent themOncology and chemotherapy denials What are the most common chemotherapy denial reasons?
The chemotherapy claim path, from prescription to appeal, and the document that prevents a denial at each step. Source: ANS, TISS standard 202609 (item 62.14) and TUSS table 38 (OCL lookup, October 17, 2026); Law 9,656/1998. Produced by Accrua.
See in the guide: Oncology and chemotherapy denials: high-cost drugs, protocols and authorizationOPME denials Four documents prove OPME use
See in the guide: OPME denials: causes and how to prove useEmergency department and urgent care denials Emergency department denials: how regularization works, from door to claim
Door-to-claim flow in the emergency department: steps 1 to 3 follow the legal guarantee of immediate care; steps 4 and 5 follow the contract with the payer. Source: Law 9,656/1998; ANS — RN 566/2022, CONSU Resolution 13/1998, TISS Standard 202609; CFM — Resolution 2,077/2014.
See in the guide: Emergency department and urgent care denials: how to fix authorization and documentationICU and long-stay denials ICU denials: how daily control of a long stay works
Daily control cycle for a long hospital stay: steps 1 to 4 repeat until discharge. Source: ANS — TISS standard, Organizational Component 202609 (extension form); TUSS tables 38 and 55. Produced by Accrua.
See in the guide: ICU and long-stay denials: how to protect every per diemDenial rate Denial rate: what is the industry benchmark?
Source: Anahp, Balanço Observatório Anahp (Anahp Observatory report), 9th edition (March 2026) and June 2026 report. Managerial initial denial as % of amounts receivable from health plans; accounting accepted denial as % of gross health plan revenue (in 2022, % of total net revenue). Produced by Accrua.
See in the guide: Denial rate: formula, industry benchmark and targetDenial appeal deadlines Denial appeals: the five deadlines RN 503 requires in the contract
Source: ANS — RN 503/2022, arts. 13 and 14; Law 9,656/1998, art. 17-A, § 2, II. The claim and denial deadlines the contract must set; the rule sets no number of days for any of them, and the health plan's response deadline must equal the appeal deadline. Produced by Accrua.
See in the guide: Denial appeal deadlines: what RN 503/2022 saysDenial appeals How to file a denial appeal, step by step
Source: ANS, RN 503/2022 and TISS standard, Organizational Component, version 202609 (September 2026). Simplified denial appeal flow between hospital and health plan. Produced by Accrua.
See in the guide: Denial appeals: how to file one, step by step, with a ready-to-use templateTypes of denials Types of denials: administrative, technical and across-the-board, side by side
Market classification of denial types in Brazil (not an ANS definition), based on RN 503/2022, the TISS standard and TUSS table 38. Produced by Accrua.
See in the guide: Types of denials: administrative, technical and across-the-board
