Document Submission in TISS 4: how it works

In the context of Supplementary Health Information Exchange (TISS), the structured submission of documents between providers and payers is essential to ensure the traceability, standardization and interoperability of care and administrative information.

To meet this need, TISS 4 provides for the Document Submission message, which allows files related to plan members’ care to be attached and transmitted throughout the entire care and financial cycle.

This feature is used in processes such as requests, authorization, billing, denial appeals and auditing, provided there is a prior agreement between provider and payer on its use.

What is Document Submission?

Document Submission is the message sent by the provider to the payer, containing documents linked to forms, batches or care items. In turn, Document Receipt is the payer’s return message to the provider, confirming that the files sent were duly received.

This structure enables the secure transmission of documents used in plan members’ care, making it easier to exchange additional information throughout the relationship between providers and payers, especially at critical stages such as audits and denial appeals.

How are files sent?

The Document Submission message is transmitted in XML format, while the content of the attached files is sent in binary form, encoded in BASE64. The payer can view the submitted documents in full.

The file formats permitted by TISS are:

• JPG or JPEG;

• PDF;

• PNG;

• TIFF.

Although the TISS manuals do not go into detail on patient privacy in this flow, the National Supplementary Health Agency (ANS) links patient and document through the form numbers, without directly including sensitive personal data in the messages, which contributes to greater information security, in compliance with the LGPD (Brazil’s General Personal Data Protection Law).

What are the fields of the Document Submission message?

Below are the main fields that make up this message, according to the TISS standard:

01 – numeroLote
Number that identifies, at the service provider, the batch to which the document will be linked.
Filling condition: required when the submission refers to a Form Batch and/or a Denial Appeal.

02 – numeroProtocolo
Number assigned by the payer to the batch of forms sent by the provider, to which the document will be linked.
Filling condition: required when the submission refers to a Form Batch and/or a Denial Appeal.

03 – numeroGuiaPrestador
Number that identifies, at the service provider, the form to which the document will be linked.
Filling condition: conditional; must be provided when the submission refers to a specific form or item.

04 – numeroGuiaOperadora
Number that identifies the form, assigned by the payer, to which the document will be linked.
Filling condition: required when the submission refers to a specific form or item.

05 – numeroDocumento
Unique identifier of the document at the service provider.
Required field.

06 – naturezaGuia
Defines the nature of the form, according to TISS domain table No. 56.
Permitted values:
1 – Request
2 – Billing
3 – Denial appeal

07 – formatoDocumento
Format of the attached file.
Required field.
Permitted values:
1 – JPG or JPEG
2 – PDF
3 – PNG
4 – TIFF

08 – seqReferenciaItem
Sequential reference number of the procedure or care item to which the document is linked.
Must be filled in when the document refers to a specific item, such as test reports or OPME packaging.

09 – documento
Content of the document encoded in the BASE64 standard.

10 – tipoDocumento
Indicates the type of document, according to TISS domain table No. 81.
The main types include:

• Proof of eligibility;

• Report, order, statement or prescription from the healthcare professional;

• Proof of attendance;

• Packaging/label of materials and medications;

• Invoices;

• Anesthesia record;

• Imaging tests and clinical analyses;

• Consent form;

• Prior authorization;

• Audit report.

11 – observacao
Optional field for notes or justifications related to the care provided.
URLs may not be included.

12 – assinaturaDigital
Digital signature of the provider responsible for sending the message.
Must be used when the document type requires a digital signature, according to TISS rules.