How to use the TISS table: 10 practical applications

Hospitals that serve health plans face a major challenge: the accepted denial rate among members of the National Association of Private Hospitals (Anahp) jumped from 0.78% of gross revenue from health plans in 2021 to 1.96% in 2024, according to the Anahp Observatory 2025.

A significant share of these denials stems from filling errors, inadequate coding and communication failures with payers. These are problems that the correct use of the TISS table helps prevent.

Many billing teams, however, still use TISS only to meet a regulatory requirement. This article details 10 practical applications that turn TISS into a financial and operational management tool.

What the TISS table is and why it is mandatory

The TISS table (Supplementary Health Information Exchange) is a set of technical standards that governs all information exchange between providers and payers in Brazil’s private healthcare (supplementary health) system. It covers the formats of care forms, procedure codes, XML file layouts for electronic submission and the validation rules for the information transmitted.

It is mandatory under Normative Resolution No. 305/2012 of the ANS (Brazil’s National Supplementary Health Agency), which made the use of the TISS standard compulsory for all private health plan operators and their in-network providers. Failure to comply with the standard’s rules can result in automatic denials, rejected forms and, in more serious cases, regulatory penalties. The standard’s official documentation is available on the ANS website.

In 2025, the ANS published version 4.01 of the standard, with significant changes to document submission and the XML structure. The details of these updates are in the article TISS 4.01: what changed and how to adapt your billing.

10 practical applications of the TISS table in hospital billing

Denial prevention and compliance

1. Fill in forms with the correct mandatory fields

TISS defines precisely which fields are mandatory for each type of form: consultation, SADT (diagnostic and therapeutic services), hospital admission and fees. Filling in these fields correctly, with the codes and information in the required format, prevents the payer from automatically rejecting the form even before the clinical review.

A practical example: on the hospital admission form, the admission and discharge date and time fields must be consistent with each other. If the end time goes past midnight, the end time field must record 23:59, because the system does not accept an end date earlier than the start date. Ignoring this kind of detail generates avoidable denials.

2. Reduce administrative and technical denials

Administrative denials arise from formal inconsistencies: an incorrect procedure code, a blank field, a discrepancy between what was authorized and what was charged. TISS standardizes the language between provider and payer, narrowing the room for conflicting interpretations. Learn more about the topic in Claim denials: what they are and how to prevent them.

When a surgical procedure is entered with the correct TISS code, both the hospital and the payer start from the same reference. This eliminates one of the main drivers of technical denials: ambiguity in identifying the procedure performed.

3. Comply with ANS rules

As we have seen, ANS Normative Resolution No. 305/2012 made the use of the TISS standard mandatory for all payers and their in-network providers. The standard determines not only the format of the forms but also transmission deadlines, file layouts and electronic validation rules.

Hospitals that comply with TISS avoid batch rejections, reduce rework for the billing team and keep the payment flow within contractual deadlines.

Operational efficiency

4. Standardize communication with multiple payers

A mid-sized hospital may work with 10, 20 or more different payers at the same time. Each has its own contractual particularities, but the TISS standard unifies the language of information exchange. This allows the billing team to run a single process, without having to adapt forms and formats for each health plan.

5. Make internal and external auditing easier

Records aligned with the TISS standard make auditing more objective and faster. In internal auditing, the team can identify inconsistencies by form type, procedure or period more precisely. In external auditing, carried out by the payer or by regulators, compliance with the standard reduces review time and the risk of disputes.

6. Monitor billing performance indicators

The standardized structure of TISS makes it possible to extract consistent data on volume of care, procedures performed, amounts charged and denial rates by form type. With this information organized, the manager can track indicators such as the denial rate and the average time to payment, two of the main gauges of the hospital’s financial health.

Strategic and financial management

7. Improve control of hospital costs

The level of detail required by the TISS standard creates a precise record of all the procedures, materials and medications used in each episode of care. This granularity makes it possible to cross-check operating cost against the revenue generated, identifying procedures with negative margins or areas with a high volume of denials.

8. Support contract negotiations with payers

Hospitals with records organized under the TISS standard have concrete data to present in negotiations over price adjustments or the addition of new services. Volume of care, procedure mix and denial history by payer are objective arguments that strengthen the hospital’s position at the negotiating table.

9. Increase transparency with patients

When billing follows the TISS standard, the hospital can detail precisely the procedures performed and the amounts charged to the plan. This reduces patients’ questions about charges and builds trust in the institution.

10. Automate XML submission with TISS 4.01

Version 4.01 of the standard, in effect since 2025, brought changes to the XML structure and to the rules for submitting documents to payers. Hospitals that automate this submission with tools compatible with TISS 4.01 reduce transmission errors, eliminate manual rework and speed up the cycle between delivering the service and receiving payment.

The impact of correct TISS use on the revenue cycle

TISS directly influences three financial indicators that every hospital manager tracks: the denial rate, the average time to payment and revenue predictability.

The accepted denial rate among Anahp member hospitals reached 1.96% of gross revenue from health plans in 2024, the highest level in the last four years, according to the Anahp Observatory 2025. Much of this growth stems from failures that correct TISS use prevents: incorrectly filled fields, mismatched procedure codes and XML files that do not follow the standard required by the payer.

The average time to payment also responds to the level of compliance with the standard. Forms rejected for formal inconsistencies go back to the billing team, restarting the review cycle and delaying payment. In 2024, the average time to payment for Anahp hospitals was 68.56 days. Every avoidable rejection adds days to this figure and puts pressure on the institution’s cash flow.

Finally, revenue predictability depends on clean billing: no rework, no rejected batches and no accumulated denials. Hospitals that apply TISS in a structured way can estimate more reliably the volume of revenue receivable in each accrual period, which improves financial planning and reduces dependence on working capital.

The Rivio solution automates the use of the TISS table

Applying the TISS standard consistently requires more than the team’s technical knowledge: it requires integrated processes, continuous review and the ability to cross-check clinical data against billing rules in real time. This is where artificial intelligence makes a difference.

Rivio uses AI to manage the entire hospital revenue cycle based on the TISS standard. The platform reads and interprets clinical records, identifies inconsistencies before the patient is discharged, cross-checks information against each payer’s rules and submits the XML automatically in compliance with TISS 4.01. When a denial occurs, the system generates the appeal automatically, based on clinical evidence.

With this level of automation, hospitals and clinics no longer depend on manual reviews to ensure TISS compliance and can focus on what really matters: caring for the health of the Brazilian population.

Frequently asked questions about the TISS table

What is the difference between TISS and TUSS?

TISS (Supplementary Health Information Exchange) is the standard that governs the format and flow of information exchange between providers and payers: forms, XMLs, file layouts. TUSS (Unified Supplementary Health Terminology) is the table of procedure codes used within TISS forms. The two work together: TUSS codes the procedure, and TISS defines how that information is transmitted.

What happens if the TISS form is filled in incorrectly?

The form may be rejected automatically by the payer even before the clinical review, or denied at the audit stage. In both cases, the billing team has to correct and resubmit it, which delays payment and lengthens the average time to payment.

Did TISS 4.01 change any rules for filling in forms?

Yes. Version 4.01, in effect since 2025, brought changes to the XML structure and the rules for submitting documents. The details are in TISS 4.01: what changed and how to adapt your billing.

Who is responsible for filling in TISS correctly at the hospital?

Responsibility is shared between the care and administrative teams. The clinical record must contain the information needed for correct billing, and the billing team is responsible for coding and transmitting that information within the required standard. Failures at either end generate denials.

Is it mandatory to fill in the ICD on the SADT form?

No. According to ANS documentation, filling in the ICD on the SADT form is not mandatory and is not a valid reason for denial. The request date, on the other hand, must be filled in the corresponding field.