ANS RN 623: learn about its direct impact on management

ANS Normative Resolution No. 623/2024 (ANS is Brazil’s National Supplementary Health Agency) redefines guidelines for health plans and contracted hospitals. The rule replaces RN 395/2016 and establishes a stricter model of monitoring, standardized deadlines and traceability in member service processes. Its central goal is to increase transparency, reduce care failures and increase the capacity to resolve issues within the payers themselves.

Standardized deadlines and traceability

RN 623/2024 sets maximum deadlines for responding to member requests:

• 5 business days for low-complexity procedures.

• 10 business days for high complexity.

• 7 business days for non‑care requests.

The rule requires a protocol number to be issued immediately at the start of the interaction and real-time tracking of the request to be made available. Generic terms such as “under review” are no longer accepted.

These requirements call for a review of internal systems, adjustments to operational workflows and consistent integration between service channels, prioritization, auditing and utilization management, at the risk of being fined for noncompliance.

Stronger ombudsman offices and the need for well‑grounded responses

The ombudsman office takes on a broader role as a body for reviewing denials. Any refusal of care may be resubmitted by the member for a new review, and the response must be clear, well grounded and traceable.

This calls for:

• specific training for ombudsman teams;

• updating denial and internal review protocols;

• alignment between customer service, auditing, utilization management and legal.

The ANS expects to reduce the volume of Preliminary Intermediation Notices (NIP) through more efficient internal resolutions, which increases the responsibility of the areas involved.

Incentives for compliance and penalties for noncompliance

The regulator has announced incentive mechanisms for payers that show a consistent reduction in complaints and proven improvement in service indicators. At the same time, it is preparing stricter penalties for cases of noncompliance with RN 623/2024.

For payers, compliance is no longer just a regulatory obligation and starts to act as a competitive advantage, influencing reputation, institutional relationships and negotiations with providers.

How payers and hospitals should prepare

To ensure compliance and avoid penalties, it is advisable to:

• review service and authorization workflows;

• train customer service, ombudsman and care audit teams;

• adopt automation solutions to make reviews easier;

• create indicators for response time and resolution rate;

• strengthen internal governance with a focus on user experience and regulation.

Consistent implementation of the RN 623/2024 guidelines offers an opportunity to improve the relationship with members, reduce regulatory exposure and raise the standard of management. That takes more than updating documents: it requires a real transformation of internal processes and of the organizations’ service culture.